Epidemiology and Characterization of Canadian Traumatic Spinal Cord Injury Patient Candidates For Upper Extremity Functional Restoration Through Peripheral Nerve Transfer: An Ambispective Study

University of Alberta, Edmonton, Alberta, Canada

MT Curran JL Olson, MJ Morhart, CD Witiw, KM Chan, LG Jacques

Introduction: Nerve transfers (NTs) represent a promising strategy of improving traumatic spinal cord injury (tSCI) patient function. However, little is known about the epidemiological and injury-related aspects of this patient population. Here, we characterize tSCI patients who may benefit from NT to elucidate the number/types of tSCI patients who may benefit from this treatment.

Materials and Methods: A multicentre, prospective Canadian tSCI data registry was utilized to identify all tSCI patients presenting to participating centres between 2005-2021. Inclusion criteria consisted of: i) admission with cervical tSCI (C1-T1), ii) ³18-years-old, iii) documented tSCI according to ASIA Impairment Scale (AIS). Patients were deemed NT candidates if they had a suitable nerve donor (MRC ³4/5) and recipient (MRC £2/5). Demographic, traumatic, and neurological injury-related variables were collected and analyzed.

Results: A total of 7645 tSCI and 4227 (55%) cervical tSCI (C1-T1) patients identified. A total of 1158 patients (15% of tSCIs and 27% of cervical tSCIs) were deemed NT candidates. The most common NT patients were eligible for included an axillary to radial nerve transfer followed by musculocutaneous to anterior interosseus nerve transfer. Average NT candidate age was 51-years-old, the majority of patients were male (77%), and the average injury severity scale score was 21. The majority of patients were AIS D and A (40% and 33%, respectively), followed by AIS C (18%) and AIS B (8%) with most common neurological level of injury being C4, C5, and finally C6.

Conclusion: To our knowledge, this is the first study to detail tSCI patients that may qualify for NT from a large, multicentre prospective database. We found that a large proportion of patients with cervical tSCI could potentially benefit from this treatment option. Better characterization of this patient population will form an important first step to increase awareness and inform tSCI NT candidate identification.