Baseline and Early Differences Following Nerve and Tendon Transfers for Restoration of Upper Extremity Function in Cervical Level Spinal Cord Injury
Blair Robert Peters, MD, Department of Surgery/Section of Plastic Surgery, Washington University School of Medicine, St Louis, MO, Stephanie A Russo, MD, PhD, Washington University School of Medicine, St Louis, MO, Carie R. Kennedy, BSN, Washington University in St. Louis, St Louis, MO, Doug Ota, MD, Palo Alto Veterans Healthcare System, Palo Alto, CA, Katherine C Stenson, MD, VA St. Louis Healthcare System, St Louis, MO, Christine B. Novak, PhD, Toronto Western Hospital Hand Program, University of Toronto, Toronto, ON, Canada, John D Steeves, PhD, ICORD, Vancouver, BC, Canada, Catherine Curtin, MD, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, Ida Fox, MD, Division of Plastic Surgery, Washington University School of Medicine, Saint Louis, MO and Katharine Tam, MD, St Louis VA Medical Center, St Louis, MO
Introduction: Nerve transfers and tendon transfers have both demonstrated excellent improvements in upper extremity function in cervical level spinal cord injury (SCI). However, differences exist regarding post-operative restrictions between these two techniques. The early effects of these differences on function and health-related quality of life have not been elucidated. The purpose of this study was to prospectively compare changes in the early post-operative period of people with cervical level SCI who underwent tendon transfer (TT) or nerve transfer (NT) surgery to those who did not undergo intervention (NS).
Methods: This was a multicenter study of individuals with cervical SCI who underwent non-surgical and surgical treatment that were recruited and followed for at least one month post-operatively/post baseline. Demographic, surgical and survey data was collected. All subjects completed the SCIM (Spinal Cord Independence Measure) III and SF-36 pre-operatively and at 1 month post-operatively. Differences in scores were tested within and between groups over time.
Results: A total of 31 subjects met inclusion criteria and had complete data. There were 16 individuals in the NS group, 10 in the NT and 5 in the TT cohort. The NT cohort had significantly lower baseline SCIM scores and SF-36 physical functioning scores. Patients who underwent TT demonstrated significant declines in the early post-operative period for physical functioning and bladder and bowel management scores that were not seen in the NT or NS cohorts.
Conclusions: People with cervical SCI that undergo NT had lower physical functioning at baseline, which may reflect the wider candidacy for nerve transfer versus tendon transfer surgery. There is a measurable decrease in physical functioning scores and sphincter management in the early post-operative period that occurs following tendon transfers. This is not seen following nerve transfers. Persons undergoing TT must be prepared for an immediate post-operative decline in function. These findings have implications for the utilization and acceptability of surgical treatment and should inform pre-operative counseling and peri-operative planning and management.
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