A Future for Paralysis Patients: Nerve Transfer

Shrey Thaker ‘22

spinal_cord
Figure 1. A major site of damage that leads to limbic paralysis is the spinal/neck region.

Many years ago, the thought of paralysis was bleak and often had negative consequences for the patient’s mental state. However, because of the research of Dr. van Zyl and her group, young adult patients may have a hope of regaining their lost motor abilities. Often times, paralysis is caused by a severe infraction on spinal integrity, leading to a loss of nerve control to a certain limb. Over time, the limb can develop severe conditions in which tendons and existing nerves have atrophied. With a recent experimental surgery, doctors have been able to replace not only damaged tendons but also reconstruct nerves. 

The surgeons operated upon 10 patients and worked mostly on hand paralysis. Each patient received both a tendon transfer and a nerve transfer. The group learned that nerve transfer restores fine motor precision while the tendon transfer helps the patient regain the strength in the hand to grasp and hold objects. All of the patients were injured within 18 months of the surgery and all displayed severe damage in the C5-C7 spinal/neck region. The surgery involved attaching a donor nerve from a conducting nerve ending on one side of the partition to functional nerves on the muscle side, bypassing the spinal damage area. In order to test the success of the operation, patients’ ability to grasp, extend, and pinch their hands was measured before, one day after, and two years following the surgery. Despite some failed outcomes in a few patients, the majority of the outlook appears promising. 

Another benefit of combining tendon and nerve transfers includes shorter immobilization time following the surgical procedure. A major contributing factor to the effectiveness of restoring limb functionality is the immediate and intensive physical therapy required for a defined period of time. However, if a patient is incapable of utilizing their new appendages because of surgical recovery time, then chances of success start to diminish. This new technique allows patients to begin physical therapy earlier, which increases their ability to function normally in the coming years. A limitation of this approach is the necessity of a patient to be injured within 6-12 months, or else the nerve transfer will prove ineffective. Though the procedure is relatively new, further refinements can be made to apply such reconstruction to more complex nerves and more severe damage.

 

References

  1. N. van Zyl, et al., Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series. The Lancet, (2019). doi: 10.1016/S0140-6736(19)31143-2
  2. Image retrieved from: https://commons.wikimedia.org/wiki/
    File:Cervical_vertebrae_lateral2.png
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