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Current Best Peripheral Nerve Transfers for Spinal Cord Injury

Hill, Elspeth J. R., M.D., Ph.D., M.Res.; Fox, Ida K., M.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 184e–198e
doi: 10.1097/PRS.0000000000005173
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Learning Objectives: After reviewing this article, the participant should be able to: 1. Understand the anatomy and pathophysiology of spinal cord injury and the resulting upper and lower motor neuron syndromes. 2. Recognize who may benefit from nerve transfers. 3. Understand the role of history, examination, imaging, and electrodiagnostics in the determination of time-sensitive lower motor neuron injury versus non–time-sensitive upper motor neuron injury. 4. Outline the surgical options and perioperative care for those undergoing nerve transfer and the expected outcomes in restoring shoulder, elbow, wrist, and hand function.

Summary: This article outlines how to localize and differentiate upper motor neuron from combined upper and lower motor neuron injury patterns in spinal cord injury by means of detailed history, physical examination, imaging, and electrodiagnostic studies to formulate appropriate surgical plans to restore function in this complex population.

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St. Louis, Mo.

From the Division of Plastic and Reconstructive Surgery, Washington University.

Received for publication January 31, 2018; accepted August 28, 2018.

This trial is registered under the name “Upper Extremity Surgery in Spinal Cord Injury,” identification number NCT01899664 (

Disclosure: Dr. Fox has funding through a Craig H. Neilsen Foundation Spinal Cord Injury Research on the Translation Spectrum (SCIRTS) entitled: Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury. Dr. Fox also has funding through a Department of Defense office of the Congressionally Directed Medical Research Programs (CDMRP) Fiscal Year 2016 Spinal Cord Injury Research Program (SCIRP) Investigator-Initiated Research Award, SC160046: W81XWH-17-1-0285 (“Supporting Patient Decisions about Upper-Extremity Surgery in Cervical Spinal Cord Injury”). The authors have no financial interest to declare in relation to the content of this article.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations published in the article.

Ida K. Fox, M.D., 1150 Northwest Tower, 660 South Euclid, St. Louis, Mo. 63110,

©2019American Society of Plastic Surgeons