• Nirbhay S Jain, HillElspeth J REJRDivision of Plastic Surgery, Washington University School of Medicine, St. Louis, MO., Craig M Zaidman, Christine B Novak, Daniel A Hunter, Neringa Juknis, Rimma Ruvinskaya, Carie R Kennedy, Joel Vetter, Susan E Mackinnon, and Ida K Fox.
• Division of Plastic Surgery, Washington University School of Medicine, St. Louis, MO.
• J Hand Surg Am. 2020 Feb 1; 45 (2): 95-103.

PurposeNerve transfer surgery is used to restore upper extremity function following cervical spinal cord injury (SCI) with substantial variation in outcomes. The injury pattern in SCI is complex and can include isolated upper motor neuron (UMN) and combined UMN/lower motor neuron (LMN) dysfunction. The purpose of the study was to determine the most effective diagnostic technique for determining suitable candidates for nerve transfer surgery in SCI.MethodsMedical records were reviewed of patients who had nerve transfers to restore upper extremity function in SCI. Data collected included (1) preoperative clinical examination and electrodiagnostic testing; (2) intraoperative neuromuscular stimulation (NMS); and (3) nerve histopathology. Preoperative, intraoperative, and postoperative data were compared to identify predictors of isolated UMN versus combined UMN/LMN injury patterns.ResultsThe study sample included 22 patients with 50 nerve transfer surgeries and included patients ranging from less than 1 year to over a decade post-SCI. Normal recipient nerve conduction studies (NCS) before surgery corresponded to the intraoperative presence of recipient NMS and postoperative histopathology that showed normal nerve architecture. Conversely, abnormal recipient NCS before surgery corresponded with the absence of recipient NMS during surgery and patterns of denervation on postoperative histopathology. Normal donor preoperative manual muscle testing corresponded with the presence of donor NMS during surgery and normal nerve architecture on postoperative histopathology. An EMG of corresponding musculature did not correspond with intraoperative donor or recipient NMS or histopathological findings.ConclusionsNCS better predict patterns of injury in SCI than EMG. This is important information for clinicians evaluating people for late nerve transfer surgery even years post-SCI.Type Of Study/Level Of EvidenceDiagnostic II.Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

12 keywords...

hide…