Comparing Gains In Function After Traditional Tendon And Novel Nerve Transfer For People With Cervical-Level Spinal Cord Injury
Caitlin A. Francoisse, MD1, Blair Peters, MD2, Catherine M. Curtin, MD3, Christine B. Novak, PhD4, Carie R. Kennedy, BSN5, Katherine Tam, MD6, Doug Ota, MD7, Katherine C. Stenson, MD6, Kashyap Tadisina, MD5, Ida Fox, MD5.
1Saint Louis University, St. Louis, MO, USA, 2Oregon Health & Science University, Portland, OR, USA, 3Stanford University, Palo Alto, CA, USA, 4University of Toronto, Toronto, ON, Canada, 5Washington University, St. Louis, MO, USA, 6Saint Louis Veterans' Healthcare System, St. Louis, MO, USA, 7Palo Alto Veterans' Healthcare System, Palo Alto, CA, USA.
PURPOSE: Tendon (TT) and nerve transfer (NT) surgery may improve function in people with cervical-level spinal cord injury (SCI)—but which is best? The purpose of this study was to quantify the degree of improvement after TT, NT, and no surgery in the setting of cervical SCI.
METHODS: This prospective multi-center study included adults with mid-level cervical SCI. Health outcomes (ability to accomplish activities of daily living and health status) were assessed using the Spinal Cord Independence Measure III (SCIM) and Short-Form Health Survey (SF-36). Demographic, surgical, and survey data were collected at the initial evaluation and between 6-24 months post-operatively/post-baseline.
RESULTS: The study included three cohorts (total number n=31): NT (n=10), TT (n=7), and no surgery (n=14). The NT group had lower SCIM scores at baseline. Both TT and NT groups demonstrated significant gains in functional status as assessed by the SCIM scores (p<0.05) compared to the non-surgical group (Figure1). There were no significant changes in the SF-36 scores between treatment groups.
CONCLUSION: Individuals undergoing upper extremity reconstruction have quantifiable gains in function following surgery compared to non-surgical patients. Functional improvements were not evident using the SF-36, which may indicate this metric is less sensitive to changes in upper extremity function. These functional improvements may encourage people with SCI and providers to consider either surgery based on their values, personal preferences, and unique circumstances. 
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