RecruitingNCT05638191

Nerve Transfer Surgery to Restore Upper-limb Function After Cervical Spinal Cord Injury

Sponsor

University of British Columbia

Enrollment

40 participants

Start Date

Jun 3, 2021

Study Type

OBSERVATIONAL

Conditions

Spinal Cord Injury Upper Extremity Paresis SCI - Spinal Cord Injury Upper Extremity Dysfunction Cervical Spinal Cord Injury Spinal Cord Injury at C5-C7 Level Upper Extremity Paralysis tetraplegia

Summary

The goal of this prospective, open-label cohort study is to assess functional outcomes in individuals with cervical spinal cord injury who have undergone nerve transfer surgery to restore upper limb function. The main questions it aims to answer are: * Does nerve transfer improve hand function in individuals with cervical spinal cord injury? * What factors are associated with functional improvement following nerve transfer? Researchers will compare functional outcomes at 24 months post-surgery to 1) baseline outcomes and 2) individuals with cervical spinal cord injury who did not undergo nerve transfer. Participants who have received nerve transfer surgery as part of their regular medical care will complete functional hand tests, electrodiagnostic assessments, and questionnaires on independence and mood every 3 months for 24 months after surgery.

Eligibility

Min Age: 18 YearsMax Age: 70 Years

Inclusion Criteria9

Traumatic, motor-complete cervical SCI (AIS A or B)
Male or female, ages 18-70
Consent and plan to undergo nerve transfer to restore grasp function in at least one limb
Motor grade 4-5 at C5
Motor grade 0-1 at C8/T1
Injury duration within 6 months at the time of surgery
English-speaking and cognitively intact
Able to provide informed written consent
Able to attend and comply with the testing protocols

Exclusion Criteria2

Inability or unwillingness to participate in post-operative rehabilitation (in person or virtual)
Secondary complication of SCI (e.g., intractable neuropathic pain, edema, contracture) or major medical comorbidity (e.g., traumatic brain injury) that would independently influence response to surgery or ability to participate in rehabilitation

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Interventions

PROCEDURENerve transfer surgery

The intervention in this study, which follows our clinical approach, is the "double nerve transfer" to restore grasp function (i.e., hand opening and hand closing). Finger and thumb extension (hand opening) is restored via the supinator-posterior interosseous nerve (PIN) transfer. Finger and thumb flexion (hand closing) is restored via a nerve transfer to the anterior interosseous nerve (AIN). There are two donor nerve options available to restore function to the muscles supplied by the AIN: the nerve to the brachialis and the nerve to the extensor carpi radialis longus (ECRL) or extensor carpi radialis brevis (ECRB).