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Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury: A More Appealing and Accessible Option for Patients
Gwendolyn Hoben, MD, PhD1; Rahul Varmun, BS1; Aimee James, PhD, MPH1; Neringa Juknis, MD2; Rimma Ruvinskaya, MD2; Christine B. Novak, PT, PhD3; Kristen Davidge, MD, MSc4; Lorna Kahn, PT, CHT5; Susan E. Mackinnon, MD1; Ida K. Fox, MD1
1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO; 2Physical Medicine and Rehabilitation, Washington University, Saint Louis, MO; 3University of Toronto, Toronto, ON, Canada; 4Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada; 5Milliken Hand Rehabilitation Center/ TRISL, Saint Louis, MO
Purpose: Restoration of hand function in people with cervical spinal cord injury (SCI) is critical to their independence and quality of life. Traditional surgeries (tendon transfers/tenodesis) are, however, remarkably under-utilized despite their well-established benefits. This study examines a series of SCI patients who underwent the relatively novel application of nerve transfers to improve hand function. The purpose was to investigate patient knowledge about treatment options and preliminary perceptions regarding nerve transfers.
Methods: A qualitative study design was used to assess five post-surgical cervical SCI patients 6-10 months after nerve transfer surgery. Asemi-structured interview was performed. Questions addressed access to health information, barriers to treatment, and perceptions of treatment options including nerve transfers.
Results: Patients reported that they received most of their health information from physicians and the internet. The major barriers to information about and access to care for upper extremity surgery were jargon and access to medical professionals. Only 3/5 reported even having previously heard about the traditional surgical treatments (tendon transfers/tenodesis). Limited post-operative downtime was the highest ranked advantage of the nerve transfer surgery. Reliability and perceived lower risk also made the nerve transfer surgery appealing. While 2/5 had at least one negative experience related to the surgery (paresthesias, transient donor site weakness), all patients reported they would have the surgery again, are considering surgery on the contralateral arm, and would recommend the surgery to others.
Conclusion: Tendon transfers and tenodesis are under-utilized options to improve hand function in SCI patients despite their benefits in improving independence and self-care. In our patient population, barriers to information regarding upper extremity surgery, including jargon and access to medical professionals, appear to contribute to this under-utilization. In comparing traditional options to nerve transfers, the lack of downtime and perceived increased reliability made nerve transfers attractive. Moreover, despite being early in their recovery (it typically takes 12-18 months to see gain in function after nerve transfer surgery), all of the patients have a positive impression of the surgery. These data provide preliminary guidance for further prospective investigation of patient perceptions of surgery to improve hand function in the setting of cervical SCI. The long term goals of this work are better dissemination of information regarding treatment and patient/provider education in this setting.
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