Which Nerve Transfers Can Restore Function After Spinal Cord Injury?
Stuti P Garg, BA, Chirag Goel, BA, Geneviève L Putnam, BS, Joshua P Weissman, BBA, Seong Park, BS, Peter Ullrich, BS and Robert D Galiano, M.D., Northwestern University Feinberg School of Medicine, Chicago, IL
Introduction: Spinal cord injury (SCI) can result in significant urinary, bowel, and genital dysfunction. Nerve transfers are potential solutions for the restoration of function after SCI. However, there remains a need to characterize nerve candidates and outcomes of treatment for SCI. The objective of this systematic review was to characterize nerve transfer strategies and outcomes for the restoration of bladder, bowel, and lower extremity function after SCI.
Materials & Methods: PubMed, Cochrane, Medline, and Embase libraries were queried according to the PRISMA guidelines for articles that presented outcomes after SCI in humans, animals, and cadavers treated with nerve transfer.
Results: Thirty-one studies with 471 subjects were included. Thirteen studies were anatomical feasibility, 11 were animal, and 7 were clinical studies. The sacral (n=218) and pudendal (n=100) nerves were injured the most (Figure 1). There were 490 nerve transfers, with genitofemoral (n=113) and femoral (n=88) nerves transferred the most. Satisfactory bladder void control was regained in 75% of sacral, 100% of intercostal, and 88% of lumbar nerve transfer patients. Spontaneous void of bowel was regained in 78% of lumbar nerve transfer patients. Two patients with lumbosacral plexus nerve root injuries had improved knee extension from grade 0/5 to 2/5 and 3/5 after obturator nerve transfer. The differences in cross sections between injured and transferred nerve pairs was 1.24 and 1.8 for femoral transfers; 1.55, 1.58, and 2.09 for sacral; and 0.22 mm2 for ilioinguinal and iliohypogastric nerve transfers (Figure 2).
Conclusions: This study demonstrates feasibility of transferring genitofemoral, femoral, sacral, and ilioinguinal nerves for the restoration of bladder, bowel, genital, and lower extremity function. While these studies suggest potential nerve transfer options, only 7 seven studies examined the outcomes in humans. Both the feasibility and applicability of nerve transfer after SCI must be explored further in clinical research.
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