Surgically Cross-transferring Cervical Nerve Roots Promotes Functional Recovery of Hemiplegic Upper Extremity Paralysis
Wen-Dong Xu, MD
Department of Hand Surgery, Huashan Hospital, Shanghai, China
Background: Contralesional hemisphere compensation can be an important recovery mechanism for upper extremity paralysis after hemispheric injuries, especially for large lesions. However, possibly due to insufficient connections from the contralesional hemisphere to the affected upper extremity, the quality of spontaneous compensation is weak and the degree is quite limited. Here, we postulate to increase this connection for greater compensation ability of the contralesional hemisphere by surgically creating a peripheral nerve cross between the unaffected and affected upper extremities.
Methods: Ten young hemiplegic patients received the cross neck C7-C7 nerve transfer surgery. Another ten patients with matched pathological conditions were assigned as the control group receiving only rehabilitation therapy.Sensorimotor functions of bilateral upper extremities were assessed. The Modified Ashworth Scale and Quality of Upper Extremity Skills Test were used for evaluating spasticity and functional use of the affected upper extremity respectively. Transcranial magnetic stimulation, functional MRI, and PET scans were used for evaluating brain activity associated with functional recovery of the affected upper extremity.
Results: Both flexor spasticity release and motor functional improvements in the affected upper extremity were observed in all ten surgery patients. There was no permanent loss of sensorimotor function of the unaffected upper extremity. Neurophysiological and neuroimaging studies showed that the functional recovery of affected upper extremity was associated with the activation of the contralesional sensorimotor cortex in surgery patients.
Conclusions: This cross neck C7-C7 nerve transfer approach may open a door to promote functional recovery of upper extremity paralysis in hemispheric neurological injuries.
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