Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed-Methods Study

Background: Cervical spinal cord injury (SCI) has a devastating effect on health and independence. Restoring upper extremity function is a top priority and can be accomplished by tendon transfer (TT) and nerve transfer (NT) surgery. The purpose of this prospective comparative study was to assess long-term changes in upper extremity function between surgical (TT or NT) and nonsurgical groups through a comprehensive mixed-methods approach. Methods: This multicenter cohort study compared data among 3 groups: those undergoing no surgery, TT surgery, or NT surgery. Quantitative data from the Spinal Cord Independence Measure (SCIM) and 36-item Short Form Health Survey were collected at baseline and long-term follow-up (6 to 24 months). Qualitative semistructured interview data were also obtained from these participants and their identified caregivers at baseline, early follow-up (1 month), and long-term follow-up (6 to 24 months). Results: Thirty-one participants had quantitative data across all time points: no surgery (n = 14), TT (n = 7), and NT (n = 10). SCIM scores improved in TT and NT groups compared with the no-surgery group (P < 0.05). The 36-Item Short Form Health Survey scores did not differ among groups. Qualitative data analysis (n = 168 interviews) corroborated SCIM findings: surgical participants and their caregivers reported improvement in transfers and ability to perform activities of daily living, including grooming and self-catheterization. Improved use of electronics and ability to operate a motor vehicle were also reported. Postoperative therapy was identified as a critical component of achieving gains. Conclusions: TT and NT surgery lead to quantitative and qualitative functional gains when compared to no surgery. This comparative information should be used to help surgeons discuss treatment options.