Nerve Transfer After Spinal Cord Injuries

Current treatment strategies of acute cervical spinal cord injuries remain limited. Treatment
options that provide meaningful improvements in patient quality of life and long-term
functional independence will provide a significant public health impact.

Specific Aim: Measure the efficacy of nerve transfer surgery in the treatment of patients
with complete cervical spinal cord injuries with no hand function. Optimize the efficiency of
nerve transfer surgery by evaluating patient outcomes in relation to patient selection and
optimal timing the the surgery.

Hypothesis: Peripheral nerve transfers in patients with spinal cord injuries will improve
hand function and provide improvement in patient quality of life and functional independence.

Inclusion Criteria:

1. 18-65 years of age

2. Informed Consent Document (ICD) signed by patient

3. Cervical spinal cord injury resulting in arm & hand functional impairment, with at
least preserved elbow function

4. International Classification of Surgery of the Hand in Tetraplegia (ICSHT) category 0
- 4

5. Patients with a stable American Spinal Injury Association (ASIA) grade of A, B, or C,
or with a diagnosis of central cord syndrome, showing minimal to no evidence of
functional improvement in motor examination after at least 6 months of non-operative
therapy post-injury

6. Appropriate candidate for nerve transfer study

7. Willing and able to comply with the study protocol

8. < 48 months from injury

Exclusion Criteria:

1. Active infection at the operative site or systemic infection

2. Any return or ongoing clinical recovery of distal motor function within 6 months after
injury

3. Physically or mentally compromised

4. Currently undergoing long-term steroid therapy

5. Significant joint contractures and/or limitations in passive range of motion in the
arm or hand

6. Active malignancy

7. Systemic disease that would affect the patient's welfare or the research study

8. Pregnant

9. Immunologically suppressed or immunocompromised

10. Significant pain or hypersensitivity

11. Previous or current injury preventing use of tendon transfers to restore upper
extremity function

12. Affective disorder of a degree that would make outcome assessment and study
participation difficult

13. History of brachial plexus injury or systemic neuropathic process