Surgeons restore hand, arm movement to quadriplegic patients

A pioneering surgical technique has restored some hand and arm movement to patients immobilised by spinal cord injuries in the neck, scientists say.
Researchers at Washington University School of Medicine in St Louis used the technique to redirect peripheral nerves in a quadriplegic's arms and hands by connecting healthy nerves to the injured nerves.
Essentially, the new nerve network reintroduces conversation between the brain and the muscles that allows patients, once again, to accomplish tasks that foster independence, such as feeding themselves or writing with a pen.
The researchers assessed outcomes of nerve-transfer surgery in nine quadriplegic patients with spinal cord injuries in the neck. Every patient in the study reported improved hand and arm function.

"Physically, nerve-transfer surgery provides incremental improvements in hand and arm function. However, psychologically, these small steps are huge for a patient's quality of life," said the study's lead author, Ida K Fox, assistant professor of plastic and reconstructive surgery.
"One of my patients told me he was able to pick up a noodle off his chest when he dropped it. Before the surgery, he couldn't move his fingers. It meant a lot for him to clean off that noodle without anyone helping him," Fox said.

Surgeons at Washington University pioneered the nerve-transfer surgery. Developed about 25 years ago by the study's senior author, Susan E Mackinnon, director of the Division of Plastic and Reconstructive Surgery at the School of Medicine, the technique initially was performed to restore movement in the extremities of patients who had injured peripheral nerves and lost the ability to move a foot or an arm.

But in the past five years, the same technique has been used to restore limited movement to patients with spinal cord injuries.
The operation can be performed even years after a spinal cord injury. It usually takes four hours, and most patients go home the next morning.
Since surgeons connect working nerves in the upper arms to a patient's damaged nerves in their arms and hands, the technique targets patients with injuries at the C6 or C7 vertebra, the lowest bones in the neck.
It typically does not help patients who have lost all arm function due to higher injuries in vertebrae C1 through C5.

Bypassing the spinal cord, surgeons reroute healthy nerves sitting above the injury site, usually in the shoulders or elbows, to paralysed nerves in the hand or arm.
Once a connection is established, patients undergo extensive physical therapy to train the brain to recognise the new nerve signals, a process that takes about 6-18 months.
The study is published in the journal Plastic and Reconstructive Surgery.