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ORIGINAL ARTICLE
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Restoring upper-limb function following cervical spinal cord injury: Current practice in the United Kingdom


1 Department of Plastic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
2 Birmingham Hand Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom

Correspondence Address:
Joseph A Ward,
Department of Plastic Surgery, Royal Marsden NHS Foundation Trust, 203 Fulham Road, Chelsea, London, SW3 6JJ
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_68_18

Objectives: Cervical spinal cord injury (CSCI) is a devastating consequence of trauma that results in disabling loss of upper-limb function. Functional reconstruction through surgical intervention can improve quality of life, reduce long-term care needs, and is highly rated by patients. Internationally, limited information exists on the number of patients eligible for surgical intervention, procedures undertaken, and provision of services. Our objective was to answer to these questions to inform service developments in the United Kingdom (UK) and abroad. Methods: A postal questionnaire survey was distributed to the clinical leads of each of the 12 UK and Republic of Ireland spinal cord injury centres (SCICs). Information was requested on the local CSCI caseload, referral of CSCI patients to reconstructive upper-limb services, and surgical procedures undertaken locally during defined periods. Nonresponders were followed up with freedom of information requests. Results: Eleven SCICs responded (response rate: 92%) with a mean of 49.6 any-level CSCI patients admitted annually (>C5: 27.9 patients, C5/6: 18 patients, <C6: 6.5 patients). No SCIC reported referring CSCI patients for nerve transfer or awareness of any peripheral nerve service. Five SCICs stated that they referred CSCI patients for surgery to restore upper-limb function. Conclusions: Surgery to restore upper-limb function following CSCI is still developing in the UK. Provision of services to this small but deserving group varies regionally. Clinical expertise is limited to a handful of SCICs where surgeons perform tendon-related procedures. No SCIC reported undertaking nerve transfer surgery. Assessment of upper-limb function should be a standard of care for functional reconstruction of CSCI with awareness of surgery among health-care professionals and patients raised.


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    -  Ward JA
    -  Power DM
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