Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case.

Autor:	Gatskiy AA; 1Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine., Tretyak IB; 1Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine., Tsymbaliuk VI; 2National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; and., Tsymbaliuk YV; 3Group of Chronic Pain Treatment, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2022 Oct 03; Vol. 4 (14). Date of Electronic Publication: 2022 Oct 03 (Print Publication: 2022).
DOI:	10.3171/CASE22301
Abstrakt:	Background: Cervical spinal cord injury (CSCI) causes severe motor deficit in upper extremities. The mixed segmental CSCI pattern is reflected in the combination of time-sensitive (TS) and non-TS myotomes in the upper extremities. Nerve transfers (NTs) restore upper extremity function yet remain TS procedures. A combination of neurological, magnetic resonance imaging (MRI), and electromyography (EMG) studies allows the identification of TS and non-TS myotomes in the upper extremities. Observations: Nineteen months after NTs, flexor pollicis longus (FPL) and deep flexor of the index finger (FDP2) recovered to M4 (right UE), FPL recovered to M3 and FDP2 to M2 (left EU). The long head of the triceps brachii muscle recovered to M4 bilaterally. The Capabilities of Upper Extremity Questionnaire (CUE-Q) score for unilateral arm functionality increased by 44% (right) and 112.5% (left) and for bilateral arm functionality by 400%; the CUE-Q score for unilateral hand and finger function increased by 283% (right) and 166% (left). Lessons: The combination of neurological, MRI, and EMG studies before surgery and data obtained during surgery provides reliable information on the CSCI pattern, specifically the availability of motor donor nerves. Simultaneous bilateral restoration is required in the event of CSCI and significantly improves the unilateral and bilateral function of the UEs.
Databáze:	MEDLINE
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