Purpose
Nerve transfer surgery is used to restore upper extremity function following cervical
spinal cord injury (SCI) with substantial variation in outcomes. The injury pattern
in SCI is complex and can include isolated upper motor neuron (UMN) and combined UMN/lower
motor neuron (LMN) dysfunction. The purpose of the study was to determine the most
effective diagnostic technique for determining suitable candidates for nerve transfer
surgery in SCI.
Methods
Medical records were reviewed of patients who had nerve transfers to restore upper
extremity function in SCI. Data collected included (1) preoperative clinical examination
and electrodiagnostic testing; (2) intraoperative neuromuscular stimulation (NMS);
and (3) nerve histopathology. Preoperative, intraoperative, and postoperative data
were compared to identify predictors of isolated UMN versus combined UMN/LMN injury
patterns.
Results
The study sample included 22 patients with 50 nerve transfer surgeries and included
patients ranging from less than 1 year to over a decade post-SCI. Normal recipient
nerve conduction studies (NCS) before surgery corresponded to the intraoperative presence
of recipient NMS and postoperative histopathology that showed normal nerve architecture.
Conversely, abnormal recipient NCS before surgery corresponded with the absence of
recipient NMS during surgery and patterns of denervation on postoperative histopathology.
Normal donor preoperative manual muscle testing corresponded with the presence of
donor NMS during surgery and normal nerve architecture on postoperative histopathology.
An EMG of corresponding musculature did not correspond with intraoperative donor or
recipient NMS or histopathological findings.
Conclusions
NCS better predict patterns of injury in SCI than EMG. This is important information
for clinicians evaluating people for late nerve transfer surgery even years post-SCI.
Type of study/level of evidence
Diagnostic II.
Key words
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Article info
Publication history
Published online: December 20, 2019
Accepted:
November 5,
2019
Received:
January 12,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2020 by the American Society for Surgery of the Hand. All rights reserved.
