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Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 152-160

Nerve transfers following cervical spinal cord injury: A review and reconstructive algorithm

1 Department of Plastic Surgery, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
2 Birmingham Hand Centre, New Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK

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

DOI: 10.4103/jmsr.jmsr_101_18

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Background: Cervical spinal cord injury (CSCI) is a devastating consequence of trauma. Restoration of upper limb function can improve quality of life, reduce long-term care needs and is highly rated by patients. Methods: We performed a non-systematic review of all studies reporting nerve transfer in CSCI to derive a putative reconstructive algorithm based primarily on nerve transfers. Results: For CSCIs above C5, no intraplexal donors exist. For CSCIs at C5 or below, axillary nerve (C5) branches may be transferred to triceps to restore elbow extension, musculocutaneous nerve (C6) branches may be transferred to the median nerve to restore pronation/ finger flexion whilst nerve branches to supinator (C6) may be transferred to re-innervate finger extensors. Further functional gains such as re-innervation of hand intrinsics, accessory respiratory function and postural control of the trunk may be possible but are not reported. Conclusions: Nerve transfers following CSCI represent an emerging area of upper limb surgery where bespoke surgical strategies undertaken early during rehabilitation course have the potential to change functional outcomes.

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