• Xu-Yun Hua, Yan-Qun Qiu, Tie Li, Mou-Xiong Zheng, Yun-Dong Shen, Su Jiang, Jian-Guang Xu, Yu-Dong Gu, and Wen-Dong Xu.
• ‡Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; ¶Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China; §State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
• Neurosurgery. 2015 Feb 1;76(2):187-95; discussion 195.

BackgroundCentral neurological injury (CNI) is a major contributor to physical disability that affects both adults and children all over the world. The main sequelae of chronic stage CNI are spasticity, paresis of specific muscles, and poor selective motor control. Here, we apply the concept of contralateral peripheral neurotization in spasticity releasing and motor function restoration of the affected upper extremity.ObjectiveA clinical investigation was performed to verify the clinical efficacy of contralateral C7 neurotization for rescuing the affected upper extremity after CNI.MethodsIn the present study, 6 adult hemiplegia patients received the nerve transfer surgery of contralateral C7 to C7 of the affected side. Another 6 patients with matched pathological and demographic status were assigned to the control group that received rehabilitation only. During the 2-year follow-up, muscle strength of bilateral upper extremities was assessed. The Modified Ashworth Scale and Fugl-Meyer Assessment Scale were used for evaluating spasticity and functional use of the affected upper extremity, respectively.ResultsBoth flexor spasticity release and motor functional improvements were observed in the affected upper extremity in all 6 patients who had surgery. The muscle strength of the extensor muscles and the motor control of the affected upper extremity improved significantly. There was no permanent loss of sensorimotor function of the unaffected upper extremity.ConclusionThis contralateral C7 neurotization approach may open a door to promote functional recovery of upper extremity paralysis after CNI.

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