Treatment of central paralysis of the upper extremity using contralateral C7 nerve transfer via the posterior spinal route - A case report.

Treatment of central paralysis of the upper extremity using contralateral C7 nerve transfer via the posterior spinal route - A case report.

World Neurosurg. 2019 Feb 07;:

Authors: Guan J, Lin J, Guan X, Jin Q

Abstract
BACKGROUND: Contralateral C7 nerve transfer is widely applied for the treatment of brachial plexus injuries or central paralysis of the upper extremities. The surgical approach has evolved from the pre-cervical subcutaneous route to the prespinal route, which is currently the most commonly used one. We report a patient with central paralysis of the right upper extremity treated with contralateral C7 nerve transfer via the posterior spinal route.
CASE PRESENTATION: A 59-year old female Han patient was admitted on July 3rd, 2018 with right hemiplegia. The muscle strength of the right lower and upper extremity with grade 4 and 0, respectively. Based on magnetic resonance imaging, she was diagnosed with central paralysis of the right upper extremity. Considering the short length of the patient's healthy C7 nerve, contralateral C7 nerve transfer via the posterior spinal route was performed. No intraoperative complication was encountered. The patient reported slight numbness of the volar side of the left thumb, middle finger, and index finger after surgery. The patient showed a right shrug movement at 1.5 months after surgery.
CONCLUSION: We propose carrying out contralateral C7 nerve transfer via the posterior spinal route, because of the shorter distance, no need for nerve transplantation, and low occurrence of the complications encountered with the prespinal route (such as vertebral artery injuries, esophageal fistula, and upper extremity pain when swallowing).

PMID: 30738934 [PubMed - as supplied by publisher]

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