Injured patients move arms and hands


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It sounds like a miracle. Tetraplegics, paralyzed from the neck down, can move their hands and arms again. An incredible phenomenon based on a sophisticated surgical technique. But let’s start from the beginning.

Classic and new method
The classic surgical restoration of arm and hand functions involves a so-called tendon transfer. The tendon of a functioning muscle is displaced and takes the function of a paralyzed muscle.However, post-injury paralyzed muscles cannot be restored.

The new method involves nerve transfer. A functioning nerve is linked to a nerve ending, which was eliminated by the injury. Along this dead nerve structure, a growth of the healthy nerve and thus an activation of the paralyzed muscle is possible. And more: A nerve transfer can restore the function of multiple muscles. In addition, multiple nerve transfers can occur simultaneously.

Combination does the job
Natasha van Zyl is a neurosurgeon from Melbourne who pioneered this work together with her group. She treated patients at an early stage after their injury at the 5th to 7th cervical level. She and her team combined both techniques. The tendon transfer brings more power while the nerve transfer brings more fine motor skills.

The surgery was a success! 10 men and 3 women with spinal cord injury underwent the surgery. In this study 59 nerve transfers were done, of which four were not successful. The patients had significantly improved functions. Namely, elbow extension, grasp, pinch and hand opening.

For the tetraplegics, this means an immense gain in quality of life. Two years after surgery they were able to eat, drink, write or use their wheelchair on their own. Some of them could even go back to work.

Outstanding results
For the first time, the result of early and multiple nerve transfer after traumatic tetraplegia was investigated. Van Zyl reports the largest prospective series of nerve transfers for tetraplegia in predominantly young people. Moreover, she did not only measure surgical improvements, but also functional outcome and evaluated patients´ satisfaction. Their technique has proven to be a safe and effective. A project that gives hope for many tetraplegic patients.

 

This study was published in the journal Lancet.

 

Source:“Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series” by van Zyl N, Hill B, Cooper C, Hahn J, Galea MP. Published in July 2019 in the journal Lancet.