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      Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

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          Abstract

          Study Design Technical report.

          Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI).

          Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer.

          Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation.

          Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

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          Most cited references 42

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          Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics.

          To investigate the impact of upper extremity deficit in subjects with tetraplegia. The United Kingdom and The Netherlands. Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations. MAIN OUTCOME PARAMETER: Indication of expected improvement in quality of life (QOL) on a 5-point scale in relation to improvement in hand function and seven other SCI-related impairments. In all, 565 subjects with tetraplegia returned the questionnaire (overall response of 42%). Results in the Dutch and the UK group were comparable. A total of 77% of the tetraplegics expected an important or very important improvement in QOL if their hand function improved. This is comparable to their expectations with regard to improvement in bladder and bowel function. All other items were scored lower. This is the first study in which the impact of upper extremity impairment has been assessed in a large sample of tetraplegic subjects and compared to other SCI-related impairments that have a major impact on the life of subjects with SCI. The present study indicates a high impact as well as a high priority for improvement in hand function in tetraplegics.
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            Motor and sensory recovery following incomplete tetraplegia.

            Fifty individuals with incomplete tetraplegia due to trauma underwent serial prospective examinations to quantify motor and sensory recovery. None of 5 patients who were motor complete with the presence of sacral (S4-S5) sharp/dull touch sensation unilaterally recovered any lower extremity motor function. However, in 8 motor complete subjects having bilateral sacral sharp/dull sensation present, the mean lower extremity motor score increased to 12.1 +/- 7.8 at 1 year. In 3 of the 8 cases, functional (> or = 3/5) recovery was seen in some muscles at 1 year. Though mean upper and lower extremity ASIA Motor Scores increased significantly (p or = 10 at 1 month were community ambulators using crutches and orthoses at 1 year follow-up.
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              Definition of complete spinal cord injury.

              Prospective serial neurological examinations were performed on 445 consecutive traumatic spinal cord injury (SCI) patients admitted for rehabilitation on an average of 22.8 +/- 15.6 days after injury. Patients were categorized by both the ASIA and Sacral Sparing (SS) definitions of complete SCI, in order to compare the definitions in terms of consistency and prognostic ability. Recovery during follow-up was determined by sensory scores for light touch, sharp/dull discrimination, proprioception, and the ASIA Motor Index Score. Change in complete status was unidirectional using the SS definition and bidirectional using the ASIA definition. Twelve patients with SS complete injuries on initial examination converted to SS incomplete injuries at follow-up. No patients converted from SS incomplete to SS complete injury. Twenty three patients with ASIA complete injuries upon admission converted to ASIA incomplete status and 6 converted from ASIA incomplete status on admission to ASIA complete status at follow-up. For quadriplegics, the average motor recovery for patients changing complete status according to the ASIA definition was 11.7 +/- 10.3, which was significantly less (p less than .05) than the average recovery using the SS definition (group 1), 17.9 +/- 9.3. For paraplegics, the average motor recovery using the ASIA definition, 8.3 +/- 6.7, did not differ significantly from the value using the SS definition, 6.8 +/- 4.0.
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                Author and article information

                Journal
                Global Spine J
                Global Spine J
                10.1055/s-00000177
                Global Spine Journal
                Georg Thieme Verlag KG (Stuttgart · New York )
                2192-5682
                2192-5690
                15 December 2014
                April 2015
                : 5
                : 2
                : 110-117
                Affiliations
                [1 ]Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
                Author notes
                Address for correspondence Wilson Z. Ray, MD Department of Neurosurgery, Washington University School of Medicine 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110United States RayZ@ 123456wudosis.wustl.edu
                Article
                1400114
                10.1055/s-0034-1396760
                4369208
                © Thieme Medical Publishers
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