Combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for treating limb hemiplegia after stroke

Abstract

Background

Contralateral C7 to C7 cross nerve transfer has been proved to be safe and effective for patients with spastic arm paralysis due to stroke and traumatic brain injury. For the lower limb, contralateral L5 to S1 cross nerve transfer serves as a novel surgical approach. In many cases, patients with hemiplegia have both upper and lower limb dysfunction and hope to restore all limb functions within one operation. To cope with this demand, we performed combined contralateral C7 to C7 and L5 to S1 cross nerve transfer in two cases successfully.

Case description

Two patients were enrolled in this study. The first patient is a 36-year-old woman who had spasticity and hemiplegia in both upper and lower limbs on the left side after a right cerebral hemorrhage 14 years prior. The second patient is a 64-year-old man who suffered from permanent muscle weakness in his right limbs, especially the leg, after a left cerebral hemorrhage 7 years prior. Both patients underwent the combined nerve transfer to improve upper and lower limb motor functions simultaneously. During the 10-month follow-up after surgery, the limb functions of both patients improved significantly.

Conclusions

This study demonstrates the safety and benefits of combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for hemiplegic patients after stroke. This novel combined surgical approach could provide an optimal choice for patients suffering from both upper and lower limb dysfunction, to reduce hospital stay while reducing financial burden.

Keywords:

• Motor dysfunction
• nerve transfer
• spastic hemiplegia
• stroke

Acknowledgments

The authors wish to acknowledge Xianggui-Chen, Gaowei-Lei MD for their help in data collection for this study.

Disclosure statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This work was supported by National Natural Science Foundation of China [81972157, 81525009], Shanghai Top Priority Clinical Medicine Center Construction Project [2017ZZ01006], and Chinese Academy of Medical Sciences Research Fund [2018RU007].