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Nerve Transfer Compared to Grafting in Motor Restoration of Traumatic Nerve Injury

Friday, May 3, 2024

Presenting Author(s)

Abdel-Hameed Al-Mistarehi, MD

Post-doctoral Research Fellow
Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

IA

Ibrahim Ashruf, MD

Medical Doctor
Saint Louis University, Saint Louis, MO, USA
St. Louis, Missouri, United States
AB

Allan J. Belzberg, MD

Professor of Neurosurgery
Johns Hopkins University School of Medicine, United States
BD

Bryan Dong, n/a

Student
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, United States
RJ

Ryan Johnson, n/a

Student
Capitol Technology University, Laurel, MD, USA, United States
JK

Jawad Khalifeh, MD

Resident
Johns Hopkins Department of Neurosurgery
Baltimore, Maryland, United States
DL

Daniel Lubelski, MD

Assistant Professor
Johns Hopkins University
Baltimore, Maryland, United States
LM

Luke MacLean, n/a

PhD
Department of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada, United States
BM

Benjamin Z. Mendelson, n/a

Medical Student
West Virginia University School of Medicine, United States
SN

Sushanth Neerumalla, n/a

Research Associate
Johns Hopkins Department of Neurosurgery, United States
NO

Nicholas Orlando, BA

Medical Student
Johns Hopkins University School of Medicine, United States
ST

Sami Tuffaha, MD

Assistant Professor of Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine, United States
Yuanxuan Xia, MD

Resident
Johns Hopkins University
Baltimore, Maryland, United States

Introduction: Various interventions can be performed to facilitate functional restoration after nerve injuries, including nerve transfers (NT) and nerve grafting (NG). We aimed to evaluate the effectiveness of NT versus NG in restoring the motor function of injured nerves.

Methods: We reviewed charts of patients who underwent surgery for traumatic nerve injuries at Johns Hopkins Medical Institutes from February 2017 to 2022. The patients were categorized into two groups: the NT and NG groups. The Medical Research Council scale was utilized to evaluate the motor outcomes.

Results: The study included 134 patients, with 91 (67.9%) of the NT group, while the NG group comprised 43 (32.1%). The mean (SD) postoperative follow-up was 10.60 (9.83) months. Compared to NG, the NT technique was significantly more prevalent among patients with brachial plexus or forearm/hand injuries and blunt-type injuries, including MVA, iatrogenic, and sports/fall traumas, and associated with longer trauma-surgery interval (p < 0.05). Two-thirds of the patients (68.7%) displayed improved outcomes at the last follow-up, with higher rates in the NT group than in NG (75.8% vs. 53.5%, p=0.009). Among patients with brachial plexus injury, the double fascicular transfer (double Oberlin procedure) was the most associated with improved outcomes (89.7%) compared to the NT other than Oberlin (63.2%) and NG (42.9%) (p=0.014). Using binary logistic regression, after controlling for age, gender, surgical technique, site, side, and type of injury, length of hospital stay, injury-to-surgery interval, and abnormal preoperative EMG Findings, the NT technique was a significant predictor for the improved outcomes (OR 15.843, 95%CI 3.217–78.013, p=0.001).

Conclusion : Nerve transfer and grafting are associated with favorable motor function among patients with traumatic nerve injury, with better outcomes for nerve transfer. The Oberlin procedure is the most successful approach to restoring elbow flexion after brachial plexus injury.