CNS injury can lead to spastic upper extremity paralysis. Results of a prospective, randomized, single-blind controlled trial testing efficacy of nerve transfer with the contralateral C7 nerve root into the paralyzed limb in patients with central cerebral injury were reported in the New England Journal of Medicine. Outcomes were based on the Fugl-Meyer upper extremity scale (combination of motor, sensory function, pain, and range of motion; typically assessing recovery after stroke). Surgery and control cohorts were each 18 patients. At 12 months after randomization, the surgery group significantly improved by 17.7±5.6 points, the control group only improved by 2.6±2.0 points. Secondary outcomes included Modified Ashworth Scale showed significant spasticity improvement across all tested joints, also supporting nerve transfer surgery improves motor strength and spasticity. Longer follow-up is warranted due to the considerable distance between the C7 root and target muscles, and the mechanism of improvement needs elucidation.
New England Journal of Medecine