Nerve Transfers for Improved Hand Function Following Cervical Spinal Cord Injury
Abstract
Spinal cord injury (SCI) is a significant public health problem. SCI is typically a devastating injury, leaving most patients with permanent disability. Despite advances in acute patient management, patients with SCI are two to five times more likely to die prematurely than those without SCI. More than 50% of the 11,000-12,000 new SCIs that occur in the United States each year involve the cervical spine resulting in diminished or complete loss of arm and/or hand function. Cervical SCI patients consistently rank hand function as the most desired function above bowel and bladder function, sexual function, standing, and pain control. The overall goal of the proposed study is to evaluate the efficacy of nerve transfers to treat patients with cervical SCIs. Over the last decade, nerve transfers have been used with increasing frequency to treat peripheral nerve and/or brachial plexus injuries. Nerve transfers involve the transfer of nerve function that is less critical and/or redundant to a more critical area of motor function. Recently, these same principles used to treat peripheral nerve injuries have been applied to patients with SCIs, with promising early results. Using uninjured nerve above the level in the spine where the injury occurred, nerve transfers can provide improved upper extremity and hand function to Veterans and patients living with cervical SCIs. Since nerves below the injured segment of spine are still in continuity with the distal muscle targets (i.e., hand ), they remain receptive to reinnervation even years after SCI. In the proposed study, we will recruit 20 patients with cervical SCIs to undergo nerve transfers. Patients will undergo specific transfers based on the degree of preserved function above the area of SCI. The research will be carried out at Washington University in St. Louis, which is on the forefront for treating patients with both acute and chronic SCIs. Dr. Ray, one of the Neurosurgery spine faculty and Co-Director of the Center for Spinal Cord Injury at Washington University, will work with Dr. Dan Osei, an Orthopedic Hand Surgeon, to enroll and treat patients with subacute and chronic cervical SCIs. Over 4 years patients will undergo nerve transfers to improve upper extremity and hand function below the level of SCI. While there is still no reliable or predictable treatment for chronic SCI, nerve transfers have shown significant promise for improved upper extremity function in both subacute and chronic SCI patients. We expect Veterans and patients who are suffering with cervical SCIs will have an improved upper extremity function, quality of life, improved activities of daily living, and an increased capacity to return to work. We believe this study will provide substantial benefit to patients enrolled at our institution and expect the results to support a larger multi-institutional Phase III clinical trial.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510456
Entities
People
- Wilson Ray
Organizations
- United States Army
- Washington University in St. Louis