July 4, 2019

expert reaction to study on successful nerve transfer surgery in paralysis patients

Research, published in The Lancet, reports that nerve transfer surgery can restore some function in patients with complete paralysis. 

Dr David A. Menassa, Neuroscience Theme Lead, The Physiological Society, said:

“Individuals with mid-cervical spine injury lose the ability to open and close their hands although they do maintain some elbow, wrist and shoulder control. This fascinating prospective study finds that hand movement is significantly improved with single or multiple healthy nerve transfer surgeries. This type of surgery when combined with tendon transfer surgery maximises functional outcome with the added benefit of resuming activity shortly after the procedure as well as further improvements over the years. Nerve transfer procedures are safe though not always successful. However, when considered early in the injury phase, seem effective and offer promise for more independence through much improved hand control in individuals with this type of injury.”

Dr Mark Dallas, Associate Professor in Cellular Neuroscience, University of Reading, said:

“Rewiring of the nervous system to restore power and indeed feeling after spinal cord injury can have a huge impact in improving quality of life. This current study examined the benefits to individuals that had undergone nerve transfer surgery over the following 2 year period. As such it highlights that the restorative improvements are long lasting and lead to a greater level of independence for these individuals. It should be noted that this intervention does not restore function to a pre-injury state. That aside the current study demonstrates the benefits of the nerve rerouting surgery to improve mobility and the ability of our nervous system to adapt to injury through this intricate surgical intervention.”

Prof Tara Spires-Jones, UK Dementia Research Institute Programme Lead and Deputy Director, Centre for Discovery Brain Sciences, University of Edinburgh, said:

“This paper led by Dr Natasha van Zyl in Australia reports surgical intervention in 16 people with spinal cord injuries to hook up functional nerves to injured nerves. This study is important because the results add to the existing studies confirming functional improvements with nerve transfers over the more commonly used tendon transfer.

“It is important to keep in mind that this was still a relatively small study, not all people benefited from the transfer, and there were no control subjects in the study who did not have surgical intervention for comparison. The improvement in function will make a big difference for people with tetraplegia but it is not a complete “cure” for this type of paralysis as complete, normal function is not restored.”

* ‘Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series’ by van Zyl et al. was published in The Lancet at 23:30 UK time on Thursday 4 July.

DOI: 10.1016/S0140-6736(19)31143-2

Declared interests

Dr David Menassa: No conflict of interest declared.

Dr Mark Dallas: “I have no conflict of interest.”

Prof Tara Spires-Jones: “I have no conflicts of interest with this paper.”