Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance

Juntao Feng; Tie Li; Minzhi Lv; Sangsoo Kim; Joon-Ho Shin; Naiqing Zhao; Qingzhong Chen; Yanpei Gong; Yucheng Sun; Zaixing Zhao; Ning Zhu; Jihua Cao; Wen Fang; Bin Chen; Song Zheng; Zhu Xu; Xin Jin; Yundong Shen; Yanqun Qiu; Huawei Yin; Su Jiang; Jie Li; Ying Ying; Liwen Chen; Ying Liu; Jie Jia; Chuntao Zuo; Jianguang Xu; Yudong Gu; Wendong Xu

doi:10.1016/j.eclinm.2021.101258

Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance

EClinicalMedicine. 2022 Jan 4:43:101258. doi: 10.1016/j.eclinm.2021.101258. eCollection 2022 Jan.

Authors

Juntao Feng^{1

2}, Tie Li^{1

2}, Minzhi Lv³, Sangsoo Kim⁴, Joon-Ho Shin⁵, Naiqing Zhao³, Qingzhong Chen⁶, Yanpei Gong⁶, Yucheng Sun⁶, Zaixing Zhao⁷, Ning Zhu⁸, Jihua Cao⁷, Wen Fang⁸, Bin Chen⁹, Song Zheng⁹, Zhu Xu⁹, Xin Jin⁹, Yundong Shen^{1

2}, Yanqun Qiu^{1

2}, Huawei Yin^{1

2}, Su Jiang^{1

2}, Jie Li², Ying Ying², Liwen Chen², Ying Liu², Jie Jia^{1

2}, Chuntao Zuo¹, Jianguang Xu¹, Yudong Gu^{1

2}, Wendong Xu^{1

2

10

11}

Affiliations

¹ The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China.
³ Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.
⁴ Kim Sang Soo Microclinic, Seoul, South Korea.
⁵ Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea.
⁶ Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China.
⁷ Department of Handsurgery, Department of Neurology, Ningxia Hui Autonomous Region Wujingzong Hospital, Yinchuan, China.
⁸ Department of rehabilitation, General Hospital of Ningxia Medical University, Yinchuan, China.
⁹ Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
¹⁰ Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Shanghai, China.
¹¹ State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center of Brain Science, Department of Anatomy and Histology and Embryology, Institutes of Brain Science, Fudan University, Shanghai, China.

Abstract

Background: A previous randomized controlled trial showed contralateral seventh cervical nerve (CC7) cross transfer to be safe and effective in restoring the arm function of spastic arm paralysis patients in a specified population. Guidance on indications, safety and expected long-term improvements of the surgery are needed for clinical practice.

Methods: This is a retrospective, multicenter, propensity score-matched cohort study. All patients registered between 2013 and 2019 with unilateral spastic arm paralysis over 1 year who were registered at one of five centers in China and South Korea were included. Patients received CC7 cross transfer or rehabilitation treatment in each center. Primary outcome was the change in the upper-extremity Fugl-Meyer (UEFM) score from baseline to 2-year follow-up; larger increase indicated better functional improvements.

Findings: The analysis included 425 eligible patients. After propensity score matching, 336 patients who were 1:1 matched into surgery and rehabilitation groups. Compared to previous trial, patient population was expanded on age (< 12 and > 45 years old), duration of disease (< 5 years) and severity of paralysis (severe disabled patients with UEFM < 20 points). In matched patients, the overall increases of UEFM score from preoperative evaluation to 2-year follow-up were 15.14 in the surgery group and 2.35 in the rehabilitation group (difference, 12.79; 95% CI: 12.02-13.56, p < 0.001). This increase was 16.58 at 3-year and 18.42 at 5-year follow-up compared with the surgery group baseline. Subgroup analysis revealed substantial increase on UEFM score in each subgroup of age, duration of disease, severity of paralysis and cause of injury. No severe complication or disabling sequela were reported in the surgery group.

Interpretation: This study showed that CC7 cross transfer can provide effective, safe and stable functional improvements in long-term follow-up, and provided evidences for expanding the indications of the surgery to a wider population of patients with hemiplegia.

Keywords: Contralateral seventh cervical nerve cross transfer; Hemiplegia; Multicenter study; Real-world observation; Spastic arm paralysis.