Medical Miracle: 13 paralysed patients can now write and feed themselves after pioneering nerve surgery
Nerve transfer surgery restores hand function and elbow extension in 13 young adults with tetraplegia, which is paralysis of both the upper and lower limbs
Thirteen patients with complete paralysis can now write, feed themselves, hold a drink, and brush their teeth, thanks to a cutting-edge nerve transfer surgery conducted on them.
According to the study, these young adults had lost the use of their upper and lower limbs following traumatic spinal cord injury as a result of motor vehicle accidents or sports injuries.
The novel surgical technique conducted at Austin Health in Melbourne - which attached functioning nerves with injured nerves to restore power in paralysed muscles - enabled them to regain movement and function in their elbows and hands, according to the largest case series of this technique in people with tetraplegia (paralysis of both the upper and lower limbs).
The study participants can now perform everyday tasks independently such as feeding themselves, brushing teeth and hair, putting on make-up, handling money and credit cards, and using tools and electronic devices.
"The nerve transfer surgery is an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions to perform everyday tasks, and giving them greater independence and the ability to participate more easily in family and work life," says the findings of the study.
For people with tetraplegia, improvement in hand function is the most critical goal. The researchers say that nerve transfers are a major advance in the restoration of hand and arm function and offer a safe, reliable surgical option for people living with tetraplegia. They add that nerve transfers can achieve similar functional improvements to traditional tendon transfers, with the benefit of smaller incisions and shorter immobilization times after surgery.
“Cervical spinal cord injury is a devastating, life-changing injury, which can affect anyone at any time. Each year, 250000–500000 people worldwide acquire a spinal cord injury, with more than 50% of these injuries resulting in tetraplegia. Tetraplegia affects almost every aspect of a person’s work, family, and social life. For people living with tetraplegia, improvement in hand function is the highest-ranked goal,” says the paper.
This study was funded by the Institute for Safety, Compensation, and Recovery Research (Australia). Researchers from Austin Health, Melbourne; Epworth Monash Rehabilitation Medicine Unit, Melbourne; and The University of Melbourne, Australia, conducted the study.
For the study, 16 young adults, who had an average age 27 years, with traumatic, early (less than 18 months post injury) spinal cord injury to the neck, were referred to Austin Health for the restoration of function in the upper limb.
What is the Procedure?
During the operation, surgeons attached functioning nerves above the spinal injury to paralyzed nerves below the injury. “Traditionally, upper limb function has been reconstructed using tendon transfer surgery, during which muscles that still work - but are designed for another function - are surgically re-sited to do the work of muscles that are paralyzed. In contrast, nerve transfers allow the direct reanimation of the paralyzed muscle itself. Additionally, nerve transfers can re-animate more than one muscle at a time, have a shorter period of immobilisation after surgery (10 days in a sling versus 6-12 weeks in a brace for a nerve transfer for elbow extension), and avoid the technical problems associated with of tendon transfer surgery including tendon tensioning during surgery and mechanical failure (stretch or rupture) after surgery,” says the paper.
Participants underwent single or multiple nerve transfers in one or both upper limbs to restore elbow extension, grasp, pinch, and hand opening.
“This involved taking working nerves to expendable muscles innervated above the spinal injury and attaching them to the nerves of paralyzed muscles innervated below the injury to restore voluntary control and reanimate the paralyzed muscle,” say the findings.
The researchers say that 59 nerve transfers were completed in 16 participants (13 men and three women; 27 limbs). In 10 participants (12 limbs), nerve transfers were uniquely combined with tendon transfers to improve hand function.
The latter allowed different styles of reconstruction to be performed in each hand, enabling participants to benefit from the innate strengths of both tendon and nerve transfers. Nerve transfers restored more natural movement and finer motor control in one hand, and tendon transfers restored more power and heavy lifting ability on the other hand.
Intensive Therapy Post Surgery
Before the surgery, one year after the operation and again two years later, the participants completed assessments on their level of independence related to activities of daily living (for example, self-care, toilet, upper limb function, muscle power, grasp and pinch strength, and hand opening ability), says the paper.
Two years after surgery, and following intensive physical therapy, participants were able to reach their arm out in front of them and open their hand to pick up and manipulate objects. Restoring elbow extension improved their ability to propel their wheelchair and to transfer into bed or a car.
“At 24 months, significant improvements were noted in the hands' ability to pick up and release several objects within a specified time frame and independence,” says the study.
The researchers found that while none of the participants were able to score on the grasp or pinch strength tests before the surgery, two years later, their pinch and grasp strength was high enough to perform most of the daily activities. There were no follow-ups for two participants, while one death was reported, but which was not related to the operation.
Four nerve transfers failed in three participants, and the researchers conclude that more research will be needed to determine which people are the best candidates to select for nerve transfer surgery to minimize the incidence of failure.
The findings were published on July 4 in The Lancet.