May 16, 2012
Surgery Returns Hand’s Function After Spinal Cord Injury
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Connie K. Ho for RedOrbit.comSurgeons at Washington State University in St. Louis recently revealed that they were able to restore some hand function in a quadriplegic patient who suffered from a spinal cord injury at the C7 Vertebra, which is the lowest bone in the neck. They were able to reroute the working nerves in the arms instead of operating on the spine. The nerves are able to communicate with the brain because they´re attached to the part of the spine that´s above the injury.
The patient was able to regain semi-hand function, particularly bend his thumb and index finger, after undergoing a surgery at Barnes-Jewish Hospital and participating in a year of intensive physical therapy. According to AFP, the patient is a 71-year-old man had suffered a spinal injury in a car accident; he´s now able to feed himself small pieces of food and write with assistance. The study, published in the May 15 issue of the Journal of Neurosurgery, is believed to be the first case study that restores ability to flex the thumb and index finger.
"This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is," remarked surgeon Dr. Ida K. Fox, an assistant professor of plastic and reconstructive surgery at Washington University, in a prepared statement. "Instead, we go out to where we know things work – in this case the elbow – so that we can borrow nerves there and reroute them to give hand function."
Patients who have injuries at the C6 and C7 vertebra generally have no hand function, but can move the shoulder, elbow, and some parts of the wrist as the nerves connect to the brain and are found above the injury point. This surgery is not helpful to patients who have lost arm function in vertebra C1 through C5, which are higher parts of the spine. The surgery is very specific in the type of patient it can assist.
"It's very important to caution that this applies only to those with spinal injuries far enough down on the spine that there are remnants of nerves that are still functional above the injury that can be tapped into," stated Dr. J. Marc Simard, a professor of neurosurgery, pathology and physiology at the University of Maryland School of Medicine in Baltimore in a article by U.S. News.
Dr. Susan E. Mackinnon, chief of the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine, was the first to develop and perform the surgery. She specializes in surgeries that relate to the peripheral nerves and has initiated other similar surgeries that bring function back to the arms and legs. The surgery reported in the Journal of Neurosurgery was the first one she had done that applied the peripheral nerve technique and gave the limb function following a spinal cord injury. Mackinnon also believes that the return of limb function was as much based off of intensive therapy as it was on the surgery. Therapy helps the brain relearn how the nerves bend the elbow and complete other limb movements.
"Many times these patients say they would like to be able to do very simple things," discussed Fox in a statement. "They say they would like to be able to feed themselves or write without assistance. If we can restore the ability to pinch, between thumb and index finger, it can return some very basic independence."
Regarding the surgery, Mackinnon doesn´t believe that there´s a window of time in which it needs to be done. According to the report, the patient completed the surgery two years after his spinal injury. As long as the nerves are connected to the support of the spine, then the nerves and related muscles stay healthy even long after injury.
"The spinal cord is the control center for the nerves, which run like spaghetti all the way out to the tips of the fingers and the tips of the toes," noted Mackinnon, the director of the School of Medicine's Center for Nerve Injury and Paralysis, in a statement. "Even nerves below the injury remain healthy because they are still connected to the spinal cord. The problem is that these nerves no longer 'talk' to the brain because the spinal cord injury blocks the signals."
During the surgery, Mackinnon operated in the upper arms to work around the patient´s C7 spinal cord injury. The working nerves and the non working nerves are parallel to each other. Mackinnon was able to take a non-working nerve and plug it into a working nerve that can help the muscles that flex the elbow. Following the surgery, the bicep still flexed the elbow but the brachilais, another muscle, was used to help bend the thumb and the finger.
"This is not a particularly expensive or overly complex surgery," Mackinnon explained in the statement. "It's not a hand or a face transplant, for example. It's something we would like other surgeons around the country to do."
The surgery will have lasting effects on those who participate in it.
"One of the issues with techniques such as this is the permanence of the outcome - once done it is hard to reverse. There is an inevitable sacrifice of some healthy function above the injury in order to provide more useful function below,” said Dr. Mark Bacon, the director of research at the charity Spinal Research, to the BBC. “This may be entirely acceptable when we are ultimately talking about providing function that leads to a greater quality of life. For the limited number of patients that may benefit from this technique this may be seen as a small price to pay."
Medical professionals are positive that this surgery could help other individuals with similar treatment.
"One element that is unusual in this case is success in a 71 year old, because older individuals typically have much lower nerve and regenerative potential," said Dr. Lewis Lane, chief of hand surgery at North Shore University Hospital in New York, in an interview with AFP.