Nerve Transfers to Improve Upper Extremity Function and Quality of Life in Tetraplegic Patients
Abstract
Spinal cord injury (SCI) is the result of damage to the spinal cord either due to trauma (90% of cases) or disease (e.g., cancer). This is typically a devastating injury, leaving many 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 11-12,000 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 cervical 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 70 patients across seven sites 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 institutions with the requisite high volumes of SCIs. The lead site will be Washington University in St. Louis, which is completing a Department of Defense Spinal Cord Injury Research Program grant (SC140051/W81XWH-15-1-0456) that treated 20 patients with cervical SCIs with exciting results. Additional sites include University of Utah, University of Michigan, University of Calgary, Pennsylvania University, and University of Texas, Houston. Recruited patients will undergo nerve transfers to improve upper extremity and hand function below the level of SCI. While there is still no reliable or robust treatment for chronic SCI, nerve transfers have shown tremendous promise for improved upper extremity function in both subacute and chronic SCIs. Based on our initial single institution clinical trial, we expect Veterans and patients who are suffering cervical SCIs will have improved upper extremity function, quality of life, and activities of daily living as well as an increased capacity to return to work. Given the relative infrequency of SCI at any single institution, no major studies have been performed regarding the use of nerve transfers. There are no evidence-based guidelines on which to base clinical decision-making. The goal of this major, multi-institutional research effort is to collect critical information regarding the optimal timing, patient selection, and key indications on use of nerve transfers in a large number of individuals. We will compile this information into a definitive database that will serve as the touchstone for multidisciplinary basic, translational, and clinical research. The largest of its kind to date, this database and the research that results will directly impact the treatment of Veterans and patients suffering from a traumatic cervical SCI. We expect to leverage our existing experience utilizing nerve transfers with our co-investigators collective expertise to generate the first set of evidence-based guidelines. All participating surgeons have clinical expertise in both peripheral nerve and SCI. We expect the resu
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910854
Entities
People
- Wilson Ray
Organizations
- United States Army
- Washington University in St. Louis