@article{d57d00e96eff424396fa95d1d964d79c,
title = "Evaluation for Late Nerve Transfer Surgery in Spinal Cord Injury: Predicting the Degree of Lower Motor Neuron Injury",
abstract = "Purpose: Nerve transfer surgery is used to restore upper extremity function following cervical spinal cord injury (SCI) with substantial variation in outcomes. The injury pattern in SCI is complex and can include isolated upper motor neuron (UMN) and combined UMN/lower motor neuron (LMN) dysfunction. The purpose of the study was to determine the most effective diagnostic technique for determining suitable candidates for nerve transfer surgery in SCI. Methods: Medical records were reviewed of patients who had nerve transfers to restore upper extremity function in SCI. Data collected included (1) preoperative clinical examination and electrodiagnostic testing; (2) intraoperative neuromuscular stimulation (NMS); and (3) nerve histopathology. Preoperative, intraoperative, and postoperative data were compared to identify predictors of isolated UMN versus combined UMN/LMN injury patterns. Results: The study sample included 22 patients with 50 nerve transfer surgeries and included patients ranging from less than 1 year to over a decade post-SCI. Normal recipient nerve conduction studies (NCS) before surgery corresponded to the intraoperative presence of recipient NMS and postoperative histopathology that showed normal nerve architecture. Conversely, abnormal recipient NCS before surgery corresponded with the absence of recipient NMS during surgery and patterns of denervation on postoperative histopathology. Normal donor preoperative manual muscle testing corresponded with the presence of donor NMS during surgery and normal nerve architecture on postoperative histopathology. An EMG of corresponding musculature did not correspond with intraoperative donor or recipient NMS or histopathological findings. Conclusions: NCS better predict patterns of injury in SCI than EMG. This is important information for clinicians evaluating people for late nerve transfer surgery even years post-SCI. Type of study/level of evidence: Diagnostic II.",
keywords = "Electrodiagnostic testing, nerve transfer, spinal cord injuries, surgery, upper extremity",
author = "Jain, {Nirbhay S.} and Hill, {Elspeth J.R.} and Zaidman, {Craig M.} and Novak, {Christine B.} and Hunter, {Daniel A.} and Neringa Juknis and Rimma Ruvinskaya and Kennedy, {Carie R.} and Joel Vetter and Mackinnon, {Susan E.} and Fox, {Ida K.}",
note = "Funding Information: We would like to acknowledge Muhammad Taher Al-Lozi, MD, and Anne Connolly, MD, for their assistance with developing parameters for the preoperative electrodiagnostic studies. We would also like to acknowledge Lorna Kahn, BSPT, CHT, for assistance with preoperative work-up of patients and performance of the physical examinations. Funding to support this project from the Craig H. Neilsen Foundation Spinal Cord Injury Research on the Translation Spectrum (SCIRTS) Grant: “Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury.” Principal Investigator: Ida K. Fox, MD. REDCap database utilization supported by Clinical and Translational Science Award (CTSA) Grant [ UL1 TR000448 ] and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842 . This material includes work supported with resources and the use of facilities at the VA St. Louis Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This has been presented at the following meetings: Fox IK, Jain N, Hill E, Zaidman CM, Novak CB, Juknis J, Ruvinskaya R, Mackinnon SE. Evaluation for late nerve transfer surgery: predicting the degree of lower motor neuron injury, Tetrahand World Congress, August 30, 2018, Nottwil, Switzerland; and Jain N, Hill E, Zaidman CM, Novak CB, Juknis J, Ruvinskaya R, Mackinnon SE, Fox IK: Evaluation for late nerve transfer surgery: predicting the degree of lower motor neuron injury, American Society for Peripheral Nerve Annual Meeting, February 1, 2019, Palm Desert, CA. Funding Information: We would like to acknowledge Muhammad Taher Al-Lozi, MD, and Anne Connolly, MD, for their assistance with developing parameters for the preoperative electrodiagnostic studies. We would also like to acknowledge Lorna Kahn, BSPT, CHT, for assistance with preoperative work-up of patients and performance of the physical examinations. Funding to support this project from the Craig H. Neilsen Foundation Spinal Cord Injury Research on the Translation Spectrum (SCIRTS) Grant: ?Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury.? Principal Investigator: Ida K. Fox, MD. REDCap database utilization supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842. This material includes work supported with resources and the use of facilities at the VA St. Louis Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This has been presented at the following meetings: Fox IK, Jain N, Hill E, Zaidman CM, Novak CB, Juknis J, Ruvinskaya R, Mackinnon SE. Evaluation for late nerve transfer surgery: predicting the degree of lower motor neuron injury, Tetrahand World Congress, August 30, 2018, Nottwil, Switzerland; and Jain N, Hill E, Zaidman CM, Novak CB, Juknis J, Ruvinskaya R, Mackinnon SE, Fox IK: Evaluation for late nerve transfer surgery: predicting the degree of lower motor neuron injury, American Society for Peripheral Nerve Annual Meeting, February 1, 2019, Palm Desert, CA. Publisher Copyright: {\textcopyright} 2020 American Society for Surgery of the Hand",
year = "2020",
month = feb,
doi = "10.1016/j.jhsa.2019.11.003",
language = "English",
volume = "45",
pages = "95--103",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
number = "2",
}