Patients with quadriplegia can now utilise their hands and arms thanks to a new procedure.

Patients with quadriplegia can regain use of their arms and hands thanks to a novel surgical technique that transfers healthy nerves to dormant nerves.

In order to revive the muscles in their hands and arms that had stopped working, Dominique Tremblay and Élie Boghossian, plastic surgeons at Maisonneuve-Rosemont Hospital (MRH) and researchers at the Université de Montréal Faculty of Medicine, have developed a new method of nerve transfer that essentially entails moving some healthy nerves from eligible patients to an inactive nerve.

NewScientist

Surgeons have reanimated the hands and arms of people who are paralysed by connecting up working nerves to the injured ones, giving people the ability to use their phones, apply make-up and feed themselves again. 

The surgery is life-changing, says surgeon Natasha van Zyl at Austin Health, Australia. One of her patients is currently travelling in Europe, and another can now take his grandchild to the movies by himself – both are leading drastically more independent lives than either had before. 

Her team in Melbourne and several other small groups globally have been developing this technique over the last several years and seen promising results, but so far the medical literature has only focused on individual case studies or small retrospective studies. 

So van Zyl and her colleagues recruited 16 patients with spinal injuries that led to arm and leg paralysis, otherwise known as quadriplegia or tetraplegia. 

Most had been injured in car accidents, playing sports or through falls. If the injury is relatively high up on the spinal cord, it can lead to arm paralysis because many of the nerves through which we control our arms branch off below the injury site. 

But any arm nerves that branch away from the spinal cord above the injury site will still work, for example. van Zyl and her team spliced these working nerves to the non-functioning ones that help control vital movements in the hands and elbows. 

Two years after the surgery, and after intensive physical therapy, the study participants were able to open their hands, grasp, pinch and extend their elbows again.

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NeuroScience News

Dominique Tremblay and Élie Boghossian, plastic surgeons at Maisonneuve-Rosemont Hospital (MRH) and researchers at the the Université de Montréal Faculty of Medicine, have developed a new approach to nerve transfer that essentially consists of moving certain healthy nerves from eligible patients to an inactive nerve, in order to reanimate the muscles of their hands and arms that were no longer functioning. 

This was achieved in the case of a young quadriplegic patient of Drs. Tremblay and Boghossian, Ms. Jeanne Carrière, who regained the use of her arms and hands with this new surgical technique. “In the quadriplegic patient, we replace the nerve impulses of a nerve that does not work with a nerve that still works. 

With time and rehabilitation, the nerve impulse is reformed, and the use of the hands and arms gradually returns,” explained Dr. Tremblay—also head of the division of plastic surgery at the University of Montreal—about this great innovation in surgery.

Over the past two years, as part of a development phase, more than a dozen patients have undergone this type of reconstruction at HMR and all these procedures have been successful. 

It should be noted that all patients’ rehabilitation steps were done in close collaboration with the Institut de réadaptation Gingras-Lindsay-de-Montréal. 

It is therefore on the strength of these successes that the CIUSSS-EMTL is now able to end the development phase and offer this type of intervention to all patients who could now benefit from it.

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