ST. LOUIS — How effective is surgery in restoring upper extremity function in patients with cervical spinal cord injury (SCI)?
SVI is a devastating injury, but using tendon transfer (TT) and nerve transfer (NT) surgeries often can restore upper extremity function. A study team led by Washington University School of Medicine and including participation from the VA St. Louis and Palo Alto, CA, healthcare systems sought to assess long-term changes in UE function between surgical (TT or NT) and nonsurgical groups through a comprehensive mixed methods approach. The results were published in the journal Plastic & Reconstructive Surgery.1
For the multicenter, cohort study, the researchers compared data among three groups: those undergoing:
- no surgery,
- TT surgery or
- NT surgery.
The study team collected quantitative data from the Spinal Cord Independence Measure (SCIM) and Short Form Health Survey (SF-36), at baseline and long-term follow-up (6-24 months). The researchers also used qualitative semi-structured interview data from these participants and identified caregivers at baseline, early follow-up (1 month) and long-term follow-up (6-24 months).
Overall, 31 participants had quantitative data across all time points: no surgery (n=14), TT (n=7), and NT (n=10). The results indicated that SCIM scores improved in TT and NT groups compared to the no-surgery group (p<0.05). SF-36 scores did not differ among groups.
“Qualitative data analysis (n=168 interviews) corroborated SCIM findings: Surgical participants and their caregivers reported improvement in transfers and ability to perform activities of daily living, including grooming and self-catheterization,” the authors point out. “Improved use of electronics and ability to operate a motor vehicle were also reported. Post-operative therapy was identified as a critical component of achieving gains.”
The study concluded that both TT and NT surgery leads to quantitative and qualitative functional gains as compared to the no-surgery group. “This comparative information should be used to help surgeons discuss treatment options,” the authors advised.
- Skladman R, Francoisse CA, L’Hotta AJ, Novak CB, et. Al. Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed Methods Study. Plast Reconstr Surg. 2024 Feb 12. doi: 10.1097/PRS.0000000000011352. Epub ahead of print. PMID: 38346159..