Development of a Clinical Algorithm to Triage Potential Candidates for Upper Extremity Tendon Transfer Surgery in Individuals with Tetraplegia: A Retrospective Study

Abstract

Background: Upper extremity (U/E) function may be greatly improved after reconstructive tendon transfer surgery in individuals with tetraplegia. An effective means of triaging potential candidates would optimize the referral process to rehabilitation and surgical teams. Objectives: To propose a set of criteria to target individuals with tetraplegia who may be potential candidates to undergo comprehensive assessment prior to reconstructive U/E surgery; to apply these criteria to a group of individuals with tetraplegia to determine the percentage of eligibility for presurgical assessment; and to compare these figures with those previously reported in the literature. Setting: A rehabilitation hospital offering specialized inpatient rehabilitation following spinal cord injury in Quebec, Canada. Methods: Retrospective chart review of individuals with tetraplegia discharged from a rehabilitation hospital between April 1, 2006 and March 31, 2010. Potential eligibility for surgery was assessed based on U/E motor function, age, medical comorbidities, compliance issues, and personal preferences. In subjects who were considered ineligible based on residual U/E strength, neurological level, injury severity and age were analysed to determine trends and significance. Results: Out of 221 individuals with tetraplegia, sixteen (7.2%) were deemed potential candidates, and three (1.3%) underwent reconstructive surgery within the defined time frame. One hundred and seventy six (176) individuals were considered ineligible for surgery due to sufficient (n=140; 63.3%) or insufficient (n=36; 16.3%) U/E motor function. Neurological level, injury severity and age were all significantly associated with potential surgery eligibility. Conclusion: The use of objective criteria is advocated to triage potential candidates to be referred for comprehensive assessment prior to planning reconstructive U/E surgery. A smaller percentage of individuals with tetraplegia seem eligible for reconstructive U/E surgery than previously reported. Most individuals considered ineligible for surgery had sufficient U/E motor function, were older and had sustained an incomplete SCI.