Nerve-transfer surgery used to restore movement after spinal injuries
Dr. Michael Bavlsik uses a motorized wheelchair to visit his patients at an extended care facility in Clayton. It’s been more than three years since his spine was crushed in a severe highway collision, when he was driving a van of Boy Scouts home from a camp in Minnesota.
“The 11 boys who were in the van got out and were all unharmed, but the roof of the van was deformed and crushed me,” Bavlsik said.
Bavlsik, a father of eight, survived. The injury left him paralyzed from the chest down, though he retained some movement in his arms. That made him a candidate for a treatment that has only recently been used to help people with spinal cord injuries regain some movement: nerve-transfer surgery.
At Barnes Jewish Hospital, Dr. Ida Fox took a healthy nerve from Bavlsik’s shoulder and rerouted it to his tricep, bypassing the spinal cord. In a second surgery, she took a nerve in his upper arm and connected it to a nerve in his hand. Afterwards, the healthy nerves began to re-grow at a rate of one inch per month. More than a year later, Bavlsik continues to have improvements in the use of his wrists, elbows and grip strength.
“I can hold a pen in my hand with a little padding on it, I could hold a fat fork. At work I could hold an otoscope that I couldn’t hold before,” Bavlsik said. Adaptive technology in his car allows him to drive, as well.
Since 2009, about a dozen people with spinal cord injuries have undergone nerve transfer surgery to improve hand and wrist function at Barnes Jewish Hospital. The vast majority of patients were able to regain significant use of their hands, arms or grip strength a year after the surgery, as Fox detailed in an October article in Plastic & Reconstructive Surgery.
“I tell patients it’s like untapped gold,” Fox said. “There’s all this stuff that’s there that is below the level of spinal cord injury and is staying alive. I think, hopefully, once the nerve grows down the new root and your brain starts talking to it that you’ll get some of the function that we saw is available there.”
The surgery has major implications for people who lose movement and sensation in their arms after spinal cord injuries. According to the National Spinal Cord Injury Statistical Center, about 276,000 Americans are living with a spinal cord injury. About half of those injuries are at the cervical level on the upper part of the spine, which often means a person cannot move their legs or hands, but may retain some movement in their shoulders and elbows.
There are a few options to help people with spinal cord injuries improve movement and functionality, and nerve-transfer is one of them, said Dr. Raj Rao, an orthopedic surgeon at George Washington University and spokesperson for the American Academy of Orthopaedic Surgeons. But most are work-arounds, and don’t treat the actual injury itself.
“Even if the treatment has the potential to work, it has to work in an area that’s developed so much scar tissue because of the original injury,” Rao said. “There have been multiple things tried, including an injection of stem cells, but nothing is really proven to be effective in well-controlled studies.”
Furthermore, Rao said, people with spinal cord injuries at the C6 and C7 vertebraes are often able to see increased functionality below the level of their injury without major interventions, so it can be a challenge to tease out which improvements are the results of a surgery, and which would have happened naturally.
"This is definitely a stop-gap measure. But anything we can do to improve quality of life right now, without needing a big electronic device or something fancy, mechanical, or a splint that gets in the way or is cumbersome, is really a wonderful gift to give," Fox said.
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