Breakthrough! Rerouted nerve surgery restores hand movement in paralyzed patients

Surgeons have successfully restored mobility in the arms and hands of people dealing with paralysis, according to a new paper in the journal Plastic and Reconstructive Surgery.

The study described how surgeon’s successfully restored mobility by “rerouting” nerve impulses by linking up healthy nerves to the injured nerves. The study team used nerve-transfer surgery in nine individuals living with paralysis due to spinal cord injuries in the neck, and every patient 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,” study author Ida K. Fox, assistant professor of plastic and reconstructive surgery at Washington University in St. Louis, said in a statement.

“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.”

The concept behind the procedure was actually developed approximately 25 years ago by the study’s senior author, Dr. Susan E. Mackinnon. It initially was conducted to bring back movement in the arms and legs of patients who had damaged peripheral nerves and lost the capacity move a foot or an arm.

How does it work?

More recently, the same method has been used to bring back limited movement to individuals with spinal cord injuries. In the procedure, surgeons link up functioning nerves in the upper arms to a patient’s affected nerves in their arms and hands. Once a link is created, patients undergo extensive physical therapy to coach the brain to acknowledge the new nerve signals, a regimen that takes approximately 6 to 18 months.

The method focuses on patients with injuries at the C6 or C7 vertebraethe lowest bones in the neck. It normally does not assist patients who have lost all arm functionality due to more severe injuries in upper vertebrae.

“The gains after nerve-transfer surgery are not instantaneous,” said Mackinnon, director of the Center for Nerve Injury and Paralysis at WUStL. “But once established, the surgery’s benefits provide a way to let individuals with spinal cord injuries improve their daily lives.”

“Our innovations to address spinal cord injuries came directly from a quarter century of nerve-transfer work in nerve injury,” Mackinnon added. “We want to continue building our expertise in this area very carefully. While the surgery itself can be relatively straightforward, the decision-making is complicated. We want to encourage people with spinal cord injury to consider this option when so little is often offered or made available.”

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Feature Image: E. Holland Durando