Peripheral Nerve Transfer for Spinal Cord Injury: Lower Motoneuron Solutions for Upper Motoneuron Problems

INTRODUCTION: Nerve transfers (NTs) have been recognized as a promising strategy to improve traumatic spine cord injury (tSCI) patient function. Although different tSCI NT options have been detailed, little is known about the epidemiological and injury-related aspects of this patient population. METHODS: TSCI patients presenting to our institution were identified through a prospectively collected tSCI data registry. Inclusion criteria consisted of: i) admission with cervical tSCI (C1-T1) between 2005-2019, ii);18-years-old, iii) documented tSCI severity using the ASIA Impairment Scale (AIS). Two peripheral nerve (PN) experts independently evaluated each patient’s suitability for NT. Demographic, and traumatic and neurological injury-related variables were collected and analyzed. RESULTS: A total of 224 (32%) patients were selected for based on tSCI level (C1-T1). After initial review, there was 94% agreement between PN experts with discordant cases being discussed before reaching a final consensus. A total of 108 patients (15% of tSCIs and 48% of cervical tSCIs) were deemed appropriate NT candidates. Average age was 43-years-old and the majority were male (82/108, 76%). TSCI severity range included: 54 (50%) patients being AIS A, 17 (16%) AIS B, 34 (31%) AIS C, and 3 (3%) AIS D. AIS motor level range included: 7 (6%) C4, 40 (37%) C5, 22 (20%) C6, 38 (35%) C7, and 1 (1%) C8 patient. CONCLUSIONS: To our knowledge, this is the first study to detail the number of tSCI patients that may qualify for NT from a large prospective database. A large proportion of cervical tSCI patients were found to be candidates. Better characterizing the epidemiological and injury patterns of this patient population will form an important first step to increase awareness and inform tSCI NT candidate identification.