Upper Extremity Reconstruction in Patients With Cervical Spinal Cord Injury.

Abstract

Background: Regaining hand and upper extremity function is a functional priority for patients with cervical spinal cord injuries (SCI). Despite the high demand for upper extremity reconstruction (UER) to restore function, the utilization of these procedures remains low. This study evaluates the incidence and timing of UER in patients with cervical SCI.

Methods: The TriNetX Research Network was queried to identify patients with cervical SCI. Then, we identified patients who underwent procedures to restore motor function (nerve transfer, tendon transfer, tenodesis, or arthrodesis) and procedures to treat spasticity and contractures (neurectomy, tendon lengthening, or tenotomy) using International Classification of Diseases, 10th Revision, Current Procedural Terminology, and Systematized Nomenclature of Medicine codes. Baseline characteristics were compared between patients who received UER and those who did not. Propensity score-matched analysis was used to compare UER rates between sex and racial groups.

Results: Among 117 401 patients with SCI, only 0.8% of those with cervical SCI underwent UER, with higher utilization among patients with low cervical (C5-C8) and complete injuries. Tendon and joint procedures were more commonly performed than nerve procedures for both motor restoration and spasticity management. Nerve transfers were typically performed earlier post-injury than tendon procedures. Patients who received UER were significantly younger and more likely to have complete SCI, higher rates of psychiatric comorbidities, and lower prevalence of diabetes than those who did not undergo UER. Although overall UER rates did not differ significantly by sex, male and White patients were more likely to receive nerve-related procedures.

Conclusions: Less than 1% of cervical SCI patients underwent any form of upper extremity reconstructive procedures. Significantly more tendon procedures were performed compared with nerve procedures to both treat spasticity and restore motor function. Patients of White race and male gender were more likely to receive nerve-related UER procedures.