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Hand and arm functions restored after paralysis
A new surgical method gives new hope for paraplegics. In 13 young adults, using a new technique, the functions of the hand and elbow could be restored after complete paralysis. Those affected were able to eat and drink, wash themselves, brush their teeth, write and operate electronic devices independently after the operation.
Australian doctors at Austin Health in Melbourne used a new surgical technique for paraplegia as part of a study and were able to restore movement in limbs believed to be lost in 13 people. This case study aims to demonstrate the effectiveness of so-called nerve transfer surgery, in which functional nerves are connected to injured nerves in order to renew the strength in paralyzed muscles. The results were recently presented in the specialist journal "The Lancet".
Broken nerves can be connected to functioning ones
In people with quadriplegia, both the lower and upper limbs are completely paralyzed. Many everyday things are therefore unthinkable for those affected and they are dependent on constant help. A revolutionary method of surgery can now change this, as Australian surgeons have shown. During the operation, broken nerves from the limbs are connected to functioning nerves of the spine. As a result, the strength returned to the hands and arms of 13 participants. Two years after the operation and after intensive physiotherapy, the test subjects were able to stretch their arms out again, open their hands, pick up objects and interact with them.
Largest case study in nerve transfer surgery to date
This series of operations is the largest case study of the new nerve transfer surgery to date. A total of 16 young adults were operated on using the new method. For the most part, those affected were victims of traffic or sports accidents and were paraplegic due to a spinal cord injury to the neck. The new method worked for 13 of the 16 people. In 10 participants the nerve transfer was combined with a tendon transfer. The new technology had no effect on three people. The doctors suggest that preliminary examinations need to clarify who the new method is suitable for in order to minimize the error rate.
The most important goal: to make the hand flexible
"Improving hand function is the most important goal for people with quadriplegia," explains head of research Dr. Natasha van Zyl. By restoring the arm and hand functions, those affected can carry out everyday tasks independently. This gives them more independence and the opportunity to participate more easily in family and work life, the expert said.
Combined surgical techniques
"In addition, we have shown that nerve transmission can be successfully combined with traditional tendon transmission techniques to maximize the benefits," emphasizes the doctor. In contrast to traditional methods, nerve transfer offers the opportunity to directly reanimate paralyzed muscles. With this method, several muscle groups could be addressed at once.
Create new connections
The surgeon explains the method using an example. The team used a working nerve on the shoulder and attached it to a broken nerve in the triceps. This reactivated the triceps muscle and made it possible to straighten the elbow. To restore hand grip, the team then connected the extensor nerve of the wrist to the restored nerve. A total of 59 such nerve transmissions were performed on the 16 participants.
Despite the successes, the experts point out some restrictions on tendon transfer. The best results were achieved if the operation was carried out as soon as possible after the injury, i.e. within six to twelve months. Afterwards, extensive rehabilitation was required. It could take months for the first movements to appear and years for full strength to be achieved. Nevertheless, the doctors see the method as a complete success, especially if the failure can still be used to restore the tendon. (vb)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- van Zyl, Natasha / Hill, Bridget / Cooper, Catherine / u .: Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series, The Lancet, 2019, thelancet.com