title: Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes.
abstract: BACKGROUND
  Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury.
  
  
  METHODS
  Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes.
  
  
  RESULTS
  The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures.
  
  
  CONCLUSIONS
  Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: St. Louis, Mo.; and Toronto, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Division of Neurorehabilitation, Spinal Cord Injury Program, and the Department of Neurology, Washington University School of Medicine; the Milliken Hand Center of The Rehabilitation Institute of Saint Louis; and the Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Fox
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Davidge
authors.forename: Christine B
authors.initials: CB
authors.lastname: Novak
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Hoben
authors.forename: Lorna C
authors.initials: LC
authors.lastname: Kahn
authors.forename: Neringa
authors.initials: N
authors.lastname: Juknis
authors.forename: Rimma
authors.initials: R
authors.lastname: Ruvinskaya
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mackinnon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D066193:Cervical Cord / Q000293:injuries*; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000601:surgery*; D013127:Spinal Nerves / Q000601:surgery; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation* / Q000502:physiology; D055815:Young Adult