Spinal Cord Injury
Nerve transfers can be used in some cases of mid-cervical level spinal cord injury (SCI) to restore some arm and hand function. Dr. Fox has pioneered the use of nerve transfers in this setting and also performs tendon transfers and other surgeries to restore hand and upper extremity function in SCI (as well as peripheral nerve and other traumatic injury). Sometimes she can help lessen spasticity, contractures and treat other more unusual hand and upper extremity issues.
Every case of spinal cord injury is unique and thus it is difficult to give generalized information that applies to all people with SCI. Please note that the following information may not exactly apply to your unique situation. Dr. Fox would have to do a full exam and history to know if you are a candidate for surgery. While we cannot provide an exact cost for treatment, surgeries for nerve transfers and tendon transfers are not considered experimental and are generally covered by insurance/Medicare/Medicaid. Dr. Fox is also involved with some research studies to collect outcomes information over time on her surgeries.
- Many people with mid-level cervical SCI are candidates for delayed nerve transfer (in our previous study we found that more than half of people could have the surgery for hand opening and/or closing even years post-injury)—typically those with intact C6/C7 motor level (those with strong elbow flexion and wrist extension) are the best candidates as there are relatively expendable donors available to restore more downstream hand function
- Electrodiagnostic (EDX) testing, specifically nerve conduction studies (of the median and radial nerves) accurately predict the continuity of the lower motor neuron and can provide quantitative information about whether or not a person is a candidate for surgery and whether or not they have a ‘time sensitive’ injury pattern. Please click here to see Electrodiagnostic Testing Protocol.
- Dr. Fox is happy to accept referrals and see people with spinal cord injury; ideally, we would like to establish care at 3-6 months post-injury (not applicable in this case) as some patterns of injury are more time-sensitive and with time candidacy for the nerve transfer treatment option may diminish
- We also evaluate people for tendon transfer, spasticity, contractures, and any other more unusual hand and upper extremity issues.
- Nerve Transfer in SCI-PN Magazine Oct. 2017
- Evaluation for Late Nerve Transfer in SCI – Predicting the Degree of Lower Motor Neuron Injury – JHS 2019
- Nerve transfers to restore upper limb function in tetraplegia – The Lancet 2019
- The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury-PM&R 2018
- Using Nerve Transfer to Restore Prehension and Grasp 12 Years Following Spinal Cord Injury-SCSC 2018
- Current best peripheral nerve transfers for spinal cord injury-PRS 2019
Forms for Clinic Visit
- General Health Questionnaire for Patients with a Nerve Injury/Condition
- Spinal Cord Independence Measure (SCIM III)
- Pain Questionnaire
- SF-36 Health Survey
If you would like to schedule a patient visit with Dr. Fox, please contact her patient coordinator:
Teresa Hitz, RMA/MSIII
Fax: 314-367-0225 (ATTN: Teresa/Dr. Fox)