A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury

Neurosurg Focus. 2017 Jul;43(1):E6. doi: 10.3171/2017.5.FOCUS17245.


A successful nerve transfer surgery can provide a wealth of benefits to a patient with cervical spinal cord injury. The process of surgical decision making ideally uses all pertinent information to produce the best functional outcome. Reliance on clinical examination and imaging studies alone can miss valuable information on the state of spinal cord health. In this regard, neurophysiological evaluation has the potential to effectively gauge the neurological status of even select pools of anterior horn cells and their axons to small nerve branches in question to determine the potential efficacy of their use in a transfer. If available preoperatively, knowledge gained from such an evaluation could significantly alter the reconstructive surgical plan and avoid poor results. The authors describe their institution's approach to the assessment of patients with cervical spinal cord injury who are being considered for nerve transfer surgery in both the acute and chronic setting and broadly review the neurophysiological techniques used.

Keywords: AHC = anterior horn cell; CMAP = compound muscle action potential; EMG = electromyography; IP = interference pattern; IQ = innervation quotient; LMN = lower motor neuron; MRC = Medical Research Council; MU = motor unit; MUNE = MU number estimation; MUNIX = MU number index; MUP = MU potential; SCI = spinal cord injury; UMN = upper motor neuron; electromyography; nerve transfer; neurophysiology; quadriplegia; reconstructive neurosurgery; spinal cord injuries.

Publication types

  • Review

MeSH terms

  • Animals
  • Cervical Cord / physiopathology
  • Cervical Cord / surgery*
  • Humans
  • Nerve Transfer* / methods
  • Neurosurgical Procedures / methods
  • Spinal Cord / physiopathology
  • Spinal Cord / surgery
  • Spinal Cord Injuries / surgery*
  • Upper Extremity / physiopathology
  • Upper Extremity / surgery*