Nerve Transfers for Improved Hand Function Following Cervical Spinal Cord Injury

Spinal cord injury (SCI) is the result of damage to the spinal cord either due to trauma (90 percent of cases) or disease (eg. Cancer). This is typically a devastating injury, leaving many patients with permanent disability. Despite advances in acute patient management, patients with SCI are two to five times more likely to die prematurely than those without SCI. More than 50 percent of the 11-12,000 new SCIs that occur in the United States each year involve the cervical spine resulting in diminished or complete loss of arm and/or hand function. Cervical SCI patients consistently rank hand function as the most desired function above bowel and bladder function, sexual function, standing, and pain control. The overall goal of the proposed study is to evaluate the efficacy of nerve transfers to treat patients with cervical SCIs. Over the last decade, nerve transfers have been used with increasing frequency to treat peripheral nerve and/or brachial plexus injuries. Nerve transfers involve the transfer of nerve function that is less critical and/or redundant to a more critical area of motor function. Recently, these same principles used to treat peripheral nerve injuries have been applied to patients with SCIs, with promising early results. Using uninjured nerve above the level in the spine where the injury occurred, nerve transfers can provide improved upper extremity and hand function to veterans and patients living with cervical SCIs. Since nerves below the injured segment of spine are still in continuity with the distal muscle targets(i.e. hand ), they remain receptive to reinnervation even years after SCI.