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Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review

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Abstract

Spinal cord injury (SCI) is very common, most frequently resulting from motor vehicle accidents and falling from a height. Often, SCI occurs at the cervical level, resulting in tetraplegia, which consists of loss of effective arm and/or hand function. For these patients, hand function is considered the most desired function, above bowel, bladder and sexual function. Fortunately, understanding about nerve and tendon transfers is steadily growing, providing new surgical solutions for functional restoration in tetraplegia patients. The primary aim of this systematic review of the literature is to assess all the various ways to improve upper-limb function, using both nerve transfers and classical tendon transfers in patients suffering from tetraplegia. Surgical indications, optimum timing and contraindications were reviewed. In accordance with the International Classification for Surgery of the Hand in Tetraplegia, ten subgroups of tetraplegic patients were analysed and a proposal for treatment combining nerve and tendon transfers formulated for each subgroup, seeking alternatives to classical surgical strategies. We also sought to propose strategies that, in instances of failure, still would allow for the use of some classical surgical approach. Starting with traditional management, we proposed new strategies using tenodesis and tendon transfers in association with nerve surgery. We believe that the suggestions described in the current paper could both improve and complete current surgical strategies and contribute to ensuring that more patients benefit from these options in future.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology II, Surgery for Hand and Upper Limb, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy

    Paolo Titolo, Stefano Artiaco, Davide Ciclamini & Bruno Battiston

  2. Department of Orthopaedic and Traumatology, CTO Hospital, University of Turin, Via Zuretti 29, 10121, Turin, Italy

    Federico Fusini & Luigi Conforti

  3. Reconstructive Microsurgery and Hand surgery Unit, Istituto Giannina Gaslini, Genoa, Italy

    Chiara Arrigoni

  4. Department of Physical Medicine and Rehabilitation, Spinal Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy

    Monica Sicari

  5. Department of Neurosurgery, Unit of Clinical Neurophysiology, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy

    Gianluca Isoardo

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  1. Paolo Titolo
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Correspondence to Federico Fusini.

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Titolo, P., Fusini, F., Arrigoni, C. et al. Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review. Eur J Orthop Surg Traumatol 29, 521–530 (2019). https://doi.org/10.1007/s00590-018-2352-2

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  • DOI: https://doi.org/10.1007/s00590-018-2352-2

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