Elena KorotchenkoResearch Institute of Emergency Pediatric Surgery and Traumatology, Russia
Title: Selective median nerve transfers for young patients with spinal cord injury C5-C7
Relevance: Spinal cord injury is 1-5 cases per 100,000 population. The cervical spine accounts for 72% of the total spine in children. 25-50% of them are accompanied by spinal cord injury, which leads to profound disability. Long-term rehabilitation of such patients is usually ineffective. A severe neurological deficit almost completely restores the ability to self-service. The prospect of restoring even minimal traces for this category of patients is of fundamental importance.
Purpose: To demonstrate the possibility of restoring key functions of the hand in patients with spinal cord injury at the C5-C7 level, using the example of selective neurotization of the branches of the median nerve.
Objective: Three patients with C5-C7 level spinal cord injury 17 to 19 years old were selected for medial nerve selective nevrotization. All patients corresponded to group A according to the ASIA scale. The average circulation period is 11.3 months. At the time of admission, all patients recovered the full range of flexion/extension in the elbow joints, rotation of the forearms, flexion and extension of the wrists. However, there were no active movements in fingers, with signs of emerging contracture in the fingers flexors.
Results: Surgical tactics included selective neurotization of anterior interosseous nerve portion in median nerve with using motor branch of the musculocutaneous nerve. In one of the cases we used additional neurotization of the posterior interosseous nerve . A follow-up observation after 15 months in 2 patients showed the restoration of the function of the cylindrical grip of the hand to M4 and the restoration of the pinch grip to M3. In the third patient, follow-up was not evaluated due to the short period after the intervention. As additional effect, all thre? patients had affect of neurotomy: reduction of spasticity in the fingers.
Conclusion:Selective anterior interosseous nerve can be considered as a staged or independent operation as part of the restoration of key hand functions, which improves the quality of life of patients with spinal cord injury.