University Hospitals Birmingham (UHB) has become the first Trust in the country to carry out a new procedure aimed at restoring feeling and movement to the arms of tetraplegic patients.
One patient, father-of-three Leon Hill, sustained a cervical spine fracture resulting in paralysis of all four limbs in a road accident in 2013, and was referred to UHB following rehabilitation. Consultant surgeons from the Birmingham Hand Centre at Queen Elizabeth Hospital Birmingham (QEHB) have successfully ‘rewired’ his right arm by transferring multiple nerves with the aim of restoring independent movement in his elbow, forearm, wrist and hand.
The procedure, known as nerve transfer surgery, was first carried out on a tetraplegic patient in the US after he was left with upper and lower limb paralysis from a similar spinal cord injury.
He was able to gain independent finger function in his hands, enabling him to feed himself after 12 months, and surgeons at QEHB are hoping for similar success.
Dominic Power, consultant hand and peripheral nerve surgeon at UHB, said: “We have been treating patients with complex peripheral nerve injuries using nerve transfer surgery for several years but the extension of this technique to patients with spinal cord injury and paralysis is a recent development.
“This is a very exciting area and it is wonderful for us to be able to offer this reconstruction to patients in the UK for the first time. I want Birmingham to become a national centre for the reconstruction of nerve injury and paralysis.”
The Birmingham Hand Centre was established at UHB in 2003 and has now grown to include 11 consultant surgeons. It provides the complete spectrum of elective and trauma hand surgery, and is supported by a hand therapy service. The expansion of the major trauma service at QEHB, as well as combat military injuries seen through the Royal Centre for Defence Medicine, has resulted in increasing numbers of complex reconstructive cases, including peripheral nerve injuries. This led to the establishment of a brachial plexus and peripheral nerve injury service in 2010, although this type of work was already being carried out from 2005.
The brachial plexus is a network of nerves from the spine to the arm supplying all upper limb movement and feeling. These nerves are injured by traction in falls and road traffic collisions and are also prone to injury with gunshot wounds and stabbings.
Nerve transfer surgery involves surgical rewiring of the human nervous system to bring live nerves close to the nerve ends of nonfunctioning muscles.
Mr Power said: “Rapid regrowth of the nerve into the dennervated muscle reliably restores function and can be used in a number of clinical scenarios where nerves are not working.”
The nerve service at QEHB was resourced to provide assessment and management of four new cases a month, but the growth has been so dramatic that the hospital now receives around 40 referrals each month for assessment.
This includes upper limb nerve injury, lower limb nerve injury, nerve tumours, brachial plexus injuries, and paralysis from other causes such as degenerative spinal disc disease and spinal fractures.
Referrals are received from all over the UK and internationally, including the Middle East.
Mr Power said 42-year-old Mr Hill, who was in a collision with a van while riding his bicycle to work in Herefordshire, underwent eight hours of surgery involving the transfer of six motor nerves, two sensory nerves and a tendon.
“There was one nerve root still working to his right shoulder and upper arm, so he was able to move his shoulder but nothing else,” the surgeon added.
“So, we were able to transfer these eight nerve branches within his arm to effectively re-wire his limb. This was done by splitting the existing nerves and reconnecting them. We hope to give him the ability to reach with his arm and to grasp by restoring sensation and dexterity in his fingers.
“Surgery went well and the following day he was discharged to continue his rehabilitation.
“It is anticipated that he will begin to reinnervate the muscles in the next 2-4 months and then further improvements in strength and control will occur in the next 12-18 months.”
