Nerve Transfer for Restoration of Upper Limb Function in Traumatic Cervical Spinal Cord Injury

Abstract

Introduction: Cervical spinal cord injury (CSCI) is a devastating consequence of trauma that results in disabling loss of upper limb function. Surgical restoration can improve quality of life, reduce long-term care needs, and is highly rated by patients. Historically, expert opinion has recommended tendon transfer procedures, but there is now a renaissance of interest in selective nerve fascicle transfer to restore prehensile grip, maintain donor muscle function, and better serve patients. Due to a long-standing geographical and professional disconnect between spinal injury professionals and reconstructive hand surgeons, limited information exists regarding the number of CSCI patients eligible for nerve transfer surgery, extent of current service provision, and contemporaneous surgical practices. Objectives: (1) Conduct a survey of UK spinal cord injury centres (SCICs) to understand the number of CSCI patients eligible for nerve transfer surgery annually. (2) Survey UK health care professionals to understand the current provision of services and range of surgical interventions performed. Methodology: SCIC Questionnaire—This was distributed to the clinical leads of each UK and Éire SCIC between February and May 2015. Information was requested on the local CSCI caseload, referrals to upper limb services, and surgical procedures undertaken locally during January to December 2014. Nonresponders were followed up with freedom of information requests. Clinician Questionnaire—This was distributed to 18 spinal injury rehabilitation consultants and upper limb surgeons identified as having a relevant professional interest through a specialist interest meeting at the British Society for Surgery of the Hand Spring Meeting (BSSH) Spring Meeting 2015 and the SCIC questionnaire. The questionnaire requested information on clinician caseload, previous training, local multidisciplinary team (MDT) support, functional gains prioritized, and surgical interventions undertaken. Results: SCIC Questionnaire—In all, 11/12 SCICs responded (response rate [RR] 92%) with a mean of 49.6, any-level CSCI patients admitted annually (>C5: 27.9 patients, C5/6: 18 patients,