C7 transfer in a posterior intradural approach for treating hemiplegic upper-limbs: hypothesis and a cadaver feasibility study

Abstract

Objective: Contralateral C7 nerve root transfer surgery has been successfully applied to rescue motor function of a hemiplegic upper extremity in patients with central neurological injury. This surgical technique is challenging, and limited anatomical space makes it difficult to manipulate tissues and may lead to higher complication rates. The authors hypothesis a new surgical route in which cervical nerve roots of both donor and recipient sides are exposed from a posterior intradural approach and neurorrhaphy is performed easily and clearly. The feasibility of this operation is tested in a cadaver model.

Methods: A fresh cadaver was placed prone. After a standard midline incision and extensive cervical laminectomy, the dura and arachnoid were widely opened, and the spinal nerve roots of C6, C7, and C8 were exposed bilaterally. Nerve grafting was attempted between pairs of donor and recipient nerve roots on contralateral sides of the spinal cord. After completion of neurorrhaphy, the dura was closed.

Results: Precise neurorrhaphy could be performed intradurally between posterior and anterior nerve roots of C7 on both sides. Multiple anastomoses of C7 to various nerve roots on the contralateral side could also be performed within the same surgical field with an interposition nerve graft.

Conclusion: The posterior intradural repair idea affords many advantages, the pathway is shorter and more straightforward, which provides more access to multiple nerve roots repair in one surgical field, and is more familiar to many neurosurgeons and spine surgeons. It may potentially be adapted for clinical use.

Keywords:

• Contralateral C7 transfer
• hemiplegia
• prespinal route
• posterior intradural approach
• vertebral canal

Acknowledgment

The authors would like to show their gratitude to Professor Jiayi Zhang and Hao Zheng from State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, for their assistance in modifying figures, and Dr. Jennifer Hong from Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, One medical center drive, Lebanon, NH, USA for her assistance in correcting the grammar and improving word choice of the manuscript.

Disclosure statement

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

Additional information

Funding

This work is supported by grants from National Key R&D Program of China [2017YFC0840100 and 2017YFC0840106], and the National Natural Science Foundation of China [81501945, to Su Jiang].