Invited Review: Surgical Strategies for Functional Upper Extremity Reconstruction After Spinal Cord Injury-Article

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The article "Surgical Strategies for Functional Upper Extremity Reconstruction After Spinal Cord Injury" discusses surgical interventions for improving upper extremity function in individuals with cervical spinal cord injuries (SCI). These injuries can profoundly affect quality of life by limiting hand, wrist, and elbow movements. The article reviews techniques like tendon transfer, tenodesis, and arthrodesis, and emphasizes the growing use of nerve transfers, which should ideally be performed before permanent muscle atrophy occurs.<br /><br />Key highlights include:<br /><br />1. <strong>Surgical Techniques</strong>: Tendon transfer is a traditional method where a healthy tendon is rerouted to restore motion. Nerve transfer is newer, often involving the transfer of expendable nerves to restore function and is beneficial for its potential in improving biomechanics and independent motion. Arthrodesis involves joint fusion to stabilize position but sacrifices motion.<br /><br />2. <strong>Rehabilitation</strong>: Postoperative therapy is crucial to balance immobilization with preventing joint stiffness. Cortical retraining may help individuals adapt to the new pattern of muscle function.<br /><br />3. <strong>Collaborative Approach</strong>: A multidisciplinary team, including surgeons, rehabilitation specialists, and therapists, is vital for assessing the injury, planning surgery, and ensuring effective rehabilitation.<br /><br />4. <strong>Current Trends and Barriers</strong>: Despite promising outcomes, these surgical procedures are not widely utilized. Barriers include lack of information, time-sensitive nature of some surgeries, and hesitance due to the potential loss of function during recovery.<br /><br />5. <strong>Classifications and Timing</strong>: The International Classification for Surgery of the Hand in Tetraplegia (ICSHT) guides surgical strategies and timing based on muscle function classification. Moreover, understanding the timeline for nerve recovery and liaising closely with nerve-transfer experts maximize outcomes.<br /><br />Overall, while improving upper limb function through surgery post-SCI offers significant benefits, it remains underused due to numerous patient, provider, and systematic barriers. Increased awareness and collaboration may improve the uptake and outcomes of these interventions.

Keywords

spinal cord injury

upper extremity reconstruction

tendon transfer

nerve transfer

arthrodesis

rehabilitation

multidisciplinary team

ICSHT classification

surgical barriers

cervical SCI