Study design: Retrospective cohort study. Objectives: To quantify spontaneous upper extremity motor recovery between 6 and 12 months after spinal cord injury (SCI) to help guide timing of nerve transfer surgery to improve upper limb function in cervical SCI. Setting: Nineteen European SCI rehabilitation centers. Methods: Data was extracted from the European Multicenter Study of SCI database for individuals with mid-level cervical SCI (N = 268). Muscle function grades at 6 and 12 months post-SCI were categorized for analysis. Results: From 6 to 12 months after SCI, spontaneous surgically-relevant recovery was limited. Of all limbs (N = 263) with grade 0–2 elbow extension at 6 months, 4% regained grade 4–5 and 11% regained grade 3 muscle function at 12 months. Of all limbs (N = 380) with grade 0–2 finger flexion at 6 months, 3% regained grade 4–5 and 5% regained grade 3 muscle function at 12 months. Conclusion: This information supports early (6 month) post-injury surgical consultation and evaluation. With this information, individuals with SCI can more fully engage in preference-based decision-making about surgical intervention versus continued rehabilitation and spontaneous recovery to gain elbow extension and/or hand opening and closing.