Transferring and grafting the C7 nerve from a functioning arm to the C7 nerve of a paralyzed arm is associated with greater functional improvement and spasticity reduction compared with rehabilitation only following a chronic cerebral injury, according to results from a randomized controlled study published in the New England Journal of Medicine.
A total of 36 patients with unilateral arm paralysis for >5 years were randomly assigned to undergo either C7 nerve transfer with rehabilitation (n=18) or rehabilitation only (n=18). Investigators evaluated the 12-month change in the 66-point Fugl-Meyer upper-extremity scale total score to assess improvement in function. Additionally, improvements in spasticity were measured by the Modified Ashworth Scale.
Significantly greater improvement in arm function was observed in the patients undergoing C7 nerve transfer as assessed by a 17.7-point improvement in the Fugl-Meyer score among those in the surgery group vs 2.6 in the group undergoing rehabilitation only (difference, 15.1; 95% CI, 12.2-17.9; P <.001). In addition, significantly more patients in the surgery group experienced improvement in spasticity compared with controls (P =.02). Investigators observed connectivity between the paralyzed arm and the ipsilateral hemisphere on transcranial magnetic stimulation and functional imaging.
Because the patients in this trial were predominantly men who had cerebral lesions derived from several different causes, the findings of this study are limited and cannot be fully generalizable to a wider patient population.
The surgery group showed clear improvement in function throughout the study period, demonstrating an improved ability “to dress, wring out a towel, tie their shoes, and operate a mobile phone with the assistance of the paralyzed hand.”
Zheng MX, Hua XY, Feng JT, et al. Trial of contralateral seventh cervical nerve transfer for spastic arm paralysis. N Engl J Med. 2018;378(1):22-34.