Nerve Transfers in High Tetraplegia to Improve Patient Function and Quality of Life
Abstract
High cervical spinal cord injury (SCI) is the result of damage to the spinal cord in the upper neck resulting in permanent disability (i.e., high tetraplegia). SCIs suffered during military deployment are more likely to result in permanent paralysis, as the initial triage of care takes place in the forward operating base. In the U.S., there are over 35,000 Soldiers and civilians living with high cervical SCIs with a complete lack of upper limb function who are dependent on their caregivers for all activities of daily living (ADLs). Currently, there are no interventions available to restore function following SCI. Recently, there have been a number of important advances in surgical techniques that may help restore upper extremity function following high cervical SCI. One such advance is nerve transfers, which involve the transfer of redundant or expendable nerve function to a more critical area of motor function. Using uninjured nerve above the level of SCI, nerve transfers can provide improved upper limb function to Veterans and patients living with high cervical SCI. Since nerves below the injured segment of spine are still in continuity with the distal muscle targets (i.e., arm/hand), they remain receptive to reinnervation even years after SCI. Over the last decade, nerve transfers have been utilized with increasing frequency to treat peripheral nerve and/or brachial plexus injuries. Recently, these same principles used to treat peripheral nerve injuries have been applied to patients with SCIs, with promising early results. What Are the Goals Of The Proposed Study? The overall goal of this proposed study is to evaluate whether nerve transfers can effectively restore upper limb motor function in patients with high cervical SCI. We propose to use the nerve controlling shoulder shrug function (spinal accessory nerve) to restore elbow function in patients with high cervical SCI. The most important goal will be to see whether upper limb motor function restored by nerve transfers increase the patient’s functional independence in activities of daily living and overall quality of life over 48 months following surgery. What Populations Will It Help? This study will target a patient population in desperate need of therapeutic intervention. A patient population with no surgical or therapeutic options to improve upper extremity function and quality of life. It will be most useful for military personnel who sustained an injury to the upper cervical spine during active duty and Veterans who are already living with debilitating high cervical SCI. It is also likely be useful for adult civilians who have had a high cervical SCI due to trauma such as car accidents, assault, sport-related neck injuries, falls, or other causes. It is possible that it may help people with other causes of spinal cord dysfunction such as cancer, infection, or other diseases. How Will It Help Them? The nerve transfer surgery will provide restoration of upper limb function paralyzed by the high cervical SCI. This restored upper limb function could provide military patients with capability to independently transfer, drive a powered wheelchair, perform activities of daily living, and improve overall capacity to return to work. What Are the Potential Clinical Applications, Benefits, and Risks? There are many potential direct clinical applications. There are many patients who suffer from high cervical SCIs and must accept full body paralysis as their new normal. Nerve transfers harness the natural nerve’s capacity to regrow and can achieve control of multiple paralyzed muscles to maximize the restoration of function. The functional restoration can improve participation in activities of daily living, improve mental/social health, and quality of life. Overall, nerve transfer is a very safe surgical procedure and has no known major risks. Because the donor nerve is sacrificed to provide function to the paralyzed recipient nerve, transie
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311083
Entities
People
- Wilson Ray
Organizations
- United States Army
- Washington University in St. Louis