Abstract
The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia. From the initial subcutaneous route to the pre-spinal route and the newly-established post-spinal route, this surgical operation underwent a series of innovations and refinements, with the aim of shortening the regeneration distance and even achieving direct neurorrhaphy. Apart from surgical efforts for better peripheral nerve regeneration, brain involvement in functional improvements after CC7 transfer also stimulated scientific interest. This review summarizes recent advances of CC7 transfer in the treatment of upper-extremity paralysis of both peripheral and central causes, which covers the neuroanatomical basis, the evolution of surgical approach, and central mechanisms. In addition, motor cortex stimulation is discussed as a viable rehabilitation treatment in boosting functional recovery after CC7 transfer. This knowledge will be beneficial towards improving clinical effects of CC7 transfer.
Highlights
Brachial plexus injury (BPI) is a relatively rare, but nearly the most severe trauma, which mainly affects the youth in Surgical management for BPI includes neurolysis for nerve lesions in continuity, nerve repair and nerve grafting for lesions in discontinuity, and neurotization for root avulsions (Kachramanoglou et al 2011; Songcharoen 2008)
The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia
Considering the impact of spasticity on functional recovery after CC7 transfer (Petuchowksi et al 2018), we propose that the combination with selective peripheral neurotomy (SPN) or selective dorsal rhizotomy (SDR) of the affected cervical nerve will further improve spasticity and promote rehabilitation
Summary
Brachial plexus injury (BPI) is a relatively rare, but nearly the most severe trauma, which mainly affects the youth in. Contralesional hemisphere compensation is involved in the functional regain of limb control after unilateral brain injury (Lotze et al 2006), the sparse connection between the contralesional hemisphere and the paralyzed hand in the contralesional side, i.e. the uncrossed anterior corticospinal tract (CST), limits the compensatory capacity (Jankowska and Edgley 2006; Ziemann et al 1999) Based on this knowledge, we could infer that the release of spasticity and the restoration of brain motoric control over the limb are pivotal for the management of spastic hemiplegia.
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