Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO.
Department of Neurological Surgery, University of Iowa, Iowa City, IA.
Clin Spine Surg. 2024 Nov 1;37(9):451-458. doi: 10.1097/BSD.0000000000001699. Epub 2024 Oct 31.
A narrative review.
To summarize relevant data from representative studies investigating upper limb restorative therapies for cervical spinal cord injury.
Cervical spinal cord injury (SCI) is a debilitating condition resulting in tetraplegia, lifelong disability, and reduced quality of life. Given the dependence of all activities on hand function, patients with tetraplegia rank regaining hand function as one of their highest priorities. Recovery from cervical SCI is heterogeneous and often incomplete; currently, various novel therapies are under investigation to improve neurological function and eventually better quality of life in patients with tetraplegia.
In this article, a narrative literature review was performed to identify treatment options targeting the restoration of function in patients with cervical SCI. Studies were included from available literature based on the availability of clinical data and whether they are applicable to restoration of arm and hand function in patients with cervical SCI.
We describe relevant studies including indications and outcomes with a focus on arm and hand function. Different treatment modalities described include nerve transfers, tendon transfers, spinal cord stimulation, functional electrical stimulation, non-invasive brain stimulation, brain-machine interfaces and neuroprosthetics, stem cell therapy, and immunotherapy. As the authors' institution leads one of the largest clinical trials on nerve transfers for cervical SCI, we also describe how patients undergoing nerve transfers are managed and followed at our center.
While complete recovery from cervical spinal cord injury may not be possible, novel therapies aimed at the restoration of upper limb motor function have made significant progress toward the realization of complete recovery.
叙述性回顾。
总结有关代表性研究的相关数据，这些研究调查了用于治疗颈脊髓损伤的上肢恢复疗法。
颈脊髓损伤（SCI）是一种使人衰弱的疾病，会导致四肢瘫痪、终身残疾和生活质量下降。鉴于所有活动都依赖于手部功能，四肢瘫痪患者将恢复手部功能列为他们的首要任务之一。颈 SCI 的恢复具有异质性，且往往不完全；目前，正在研究各种新疗法以改善四肢瘫痪患者的神经功能，并最终提高他们的生活质量。
在本文中，进行了叙述性文献综述，以确定针对颈 SCI 患者功能恢复的治疗选择。根据临床数据的可用性以及它们是否适用于颈 SCI 患者手臂和手部功能的恢复，从现有文献中选择了研究。
我们描述了相关研究，包括适应症和结果，重点是手臂和手部功能。描述的不同治疗方式包括神经转移、肌腱转移、脊髓刺激、功能性电刺激、非侵入性脑刺激、脑机接口和神经假体、干细胞疗法和免疫疗法。由于作者所在机构领导着针对颈 SCI 的神经转移的最大临床试验之一，我们还描述了我们中心如何管理和随访接受神经转移的患者。
虽然颈脊髓损伤可能无法完全恢复，但旨在恢复上肢运动功能的新疗法在实现完全恢复方面取得了重大进展。
