The new nerve transfer technique means the 13, all with tetraplegia, are now able to feed themselves, hold a drink, brush their teeth and hair, put on make-up, write, handle money and credit cards, and use tools and electronic devices

By Ian Horswill

Posted on July 5, 2019

Pioneering nerve transfer surgery has taken place in Melbourne, Australia, and restored movement to the hands of 13 young adults who were paralysed in sporting or traffic accidents.

The new surgical technique means the 13, all with tetraplegia, have regained a degree of motor skills – they can once again feed themselves, hold a drink, brush their teeth and hair, put on make-up, write, handle money and credit cards, and use tools and electronic devices, according to a report published in The Lancet medical journal.

Of the between 250,000 and 500,000 people every year who suffer a spinal injury, more than half become tetraplegic.

Natasha van Zyl, of the Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, Victoria, led the research, which was funded by the Institute for Safety, Compensation, and Recovery Research (Australia).

Dr Natasha van Zyl has lead the pioneering nerve transfer surgery that has given 13 young adults with paralysis in their arms, movement in the lower arm and in the elbow.

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Dr van Zyl said the 13 patients were able to use their hands and extend their arms from the elbow.

“Extending your elbow allows you to push a wheelchair better, helps you to transfer in and out of a car, reach out and do something in space in front of you, shake someone’s hand,” she told The Guardian.

“It allows you to reach above your head, which you need to be able to do because the world is designed for standing-up people. So you can switch a light off, you can get something off a shelf. Hand function is everything you use your hand for. You would just need to tape your hands up for five minutes to experience how frustrating life would be without your hands, without your fingers.”

It took two years of extensive physical therapy after the surgery for the paralysed patient to be able to extend their elbow to propel their wheelchair and to transfer into bed or a car.

The researchers have been using combinations of tendon transfers, which result in greater strength for the muscle, and nerve transfers, which improve dexterity.

Dr Van Zyl said she hopes the research will encourage the thousands of people who become tetraplegic to seek surgery that could help them live more normal lives.

Nerve transfers are not new, she said, but had not been successful in spinal cord injuries. Dr Van Zyl told The Guardian that she had been using nerve transplants in brachial plexus injuries, where neck and shoulder nerves have been pulled out of the spinal cord, and wondered why they did not try them to restore function in patients who had been paralysed. In 2014, she and her team designed a triple nerve transplant.

The first patient had “really fabulous results from the surgery”, she said. “Word got out and we were fairly inundated with people wanting nerve transfers.”

They recruited 16 young adult patients who had become tetraplegic after motor accidents, falls, sports or diving. Two of them did not continue with the program and one died, unconnected to the surgery. Nerves were taken from shoulders and transplanted into paralysed muscles in the arm so that they bypassed the injury and connected back up to the spinal cord. Ten of the patients had nerve transfers to one arm and tendon transplants in the other. Four nerve transplants in three patients failed, but the team say tendon transplant is then available as a backup.

Two years on from surgery, the patients have significant improvements in their hand function, particularly enough pinch and grasp strength to carry out most tasks of daily living.

The Austin Health researchers said the nerve transfer surgery should be performed within a year of paralysis.