Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
PM R. 2023 Jun;15(6):790-799. doi: 10.1002/pmrj.12868. Epub 2022 Aug 27.
Peripheral nerve transfer (PNT) to improve upper limb function following cervical spinal cord injury (SCI) involves the transfer of supralesional donor nerves under voluntary control to intralesional or sublesional lower motor neurons not under voluntary control. Appropriate selection of donor and recipient nerves and surgical timing affect functional outcomes. Although the gold standard of nerve selection is intraoperative nerve stimulation, preoperative electrodiagnostic (EDX) evaluation may help guide surgical planning. Currently there is no standardized preoperative EDX protocol. This study reviews the EDX workup preceding PNT surgery in cervical SCI and proposes an informed EDX protocol to assist with surgical planning. The PICO (Population, Intervention, Comparison, Outcome) framework was used to formulate relevant Medical Subject Headings (MeSH) terms and identify published cases of PNT in cervical SCI in Medline, Embase, CINAHL, and Emcare databases in the last 10 years. The EDX techniques evaluating putative donor nerves, recipient nerve branches, time sensitivity of nerve transfer and other electrophysiological parameters were summarized to guide creation of a preoperative EDX protocol. Needle electromyography (EMG) was the most commonly used EDX technique to identify healthy donor nerves. Although needle EMG has also been used on recipient nerves, compound muscle action potential amplitudes may provide a more accurate determination of recipient nerve health and time sensitivity for nerve transfer. Although there has been progress in presurgical EDX evaluation, EMG and nerve conduction study approaches are variable, and each has limitations in their utility for preoperative planning. There is need for standardization in the EDX evaluation preceding PNT surgery to assist with donor and recipient nerve selection, surgical timing and to optimize outcomes. Based on results of this review, herein we propose the PreSCIse (PRotocol for Electrodiagnosis in SCI Surgery of the upper Extremity) preoperative EDX panel to achieve said goals through an interdisciplinary and patient-centered approach.
周围神经转移（PNT）用于改善颈脊髓损伤（SCI）后的上肢功能，涉及在自愿控制下将超病变供体神经转移至非自愿控制的病变内或病变下的低级运动神经元。供体和受体神经的适当选择以及手术时机会影响功能结果。尽管神经选择的金标准是术中神经刺激，但术前电诊断（EDX）评估可能有助于指导手术计划。目前，术前 EDX 方案尚未标准化。本研究回顾了颈 SCI 中 PNT 手术前的 EDX 检查，并提出了一种明智的 EDX 方案以协助手术计划。采用 PICO（人群、干预、比较、结局）框架制定相关的医学主题词（MeSH）术语，并在过去 10 年中在 Medline、Embase、CINAHL 和 Emcare 数据库中查找发表的颈 SCI 中 PNT 的病例。总结了评估潜在供体神经、受体神经分支、神经转移的时间敏感性和其他电生理参数的 EDX 技术，以指导术前 EDX 方案的制定。针极肌电图（EMG）是最常用于识别健康供体神经的 EDX 技术。尽管针极 EMG 也已用于受体神经，但复合肌肉动作电位幅度可能更准确地确定受体神经的健康状况和神经转移的时间敏感性。尽管术前 EDX 评估取得了进展，但 EMG 和神经传导研究方法存在差异，每种方法在术前规划中的应用都有其局限性。需要对 PNT 术前的 EDX 评估进行标准化，以协助供体和受体神经选择、手术时机，并优化结果。基于本综述的结果，我们在此提出 PreSCIse（上肢 SCI 手术中电诊断的方案）术前 EDX 方案，通过跨学科和以患者为中心的方法实现上述目标。
