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Nerve Transfers Can Improve Upper Extremity Function In Cervical Spinal Cord Injury: A Prospective Proof-of-concept Study
Kashyap K. Tadisina, M.D.1, Caitlin Francoisse, M.D.2, Christine B. Novak, PhD3, Carie Kennedy, BSN, RN1, Lorna Kahn, CHT, PT1, Aimee James, MPH, PhD1, Rimma Ruvinskaya, M.D.1, Neringa Juknis, M.D.1, Katherine Stenson, M.D.4, Susan E. Mackinnon, M.D.1, Ida K. Fox, M.D.1.
1Washington University in St. Louis, St. Louis, MO, USA, 2Saint Louis University, St. Louis, MO, USA, 3University of Toronto, Toronto, ON, Canada, 4John Cochran Veterans Affairs Medical Center, St. Louis, MO, USA.

Purpose:
Restoration of upper extremity (UE) function is important to people living with cervical spinal cord injury (SCI) and nerve transfer surgery (NT) is poised to change the treatment paradigm. In this proof-of-concept study, we hypothesized that NT can restore UE function with minimal peri-operative diminution of health-related quality of life (HRQoL).
Methods:
A prospective single-arm pre/post comparative study design was used to evaluate function and HRQoL. Adults with mid-cervical level SCI undergoing UE NT surgery were recruited. Validated outcomes measures (Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP); Spinal Cord Independence Measure (SCIM)) and qualitative semi-structured interview data were obtained and analyzed.
Results:
Ten males (mean 36.9 years old; underwent 22 NTs to restore hand function at 5.2 years post-SCI) were followed for 25.9 months. SCIM and GRASSP post-scores significantly increased in all cases (p<0.01) (Figure 1). Qualitative data showed that a majority thought the surgery was "worth it"; some had functional gains not reflected in the quantitative assessment scoring. One participant with minimal gains did not regret the surgery and was glad to "help progress the science".
Conclusions:
In people with cervical SCI, NT can improve UE movement and significantly increase function and independence. Surgical reconstructions with NT presents a viable option for individuals who may not be candidates for or prefer to avoid the perioperative morbidity associated with tendon transfer surgery.


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