This article reviews the recent advances or nerve-oriented surgical procedures in the treatment of the spastic upper limb. The idea to intervene on the nerve is not recent, but new trends have developed in nerve surgery over the past few years, stimulating experiments and research. Specific surgical procedures involving the nerves have been described at different levels from proximal to distal: at the cervical spinal cord and the dorsal root entry zone (rhizotomy), at the level of the roots (contralateral C7 transfer) or in the peripheral nerve, within the motor trunk (selective neurectomy) or as its branches penetrate the muscles (hyperselective neurectomy). All of these neurosurgical procedures are only effective on spasticity but do not address the other deformities, such as contractures and motor deficit. Additional procedures may have to be planned in conjunction with nerve procedures to optimize outcomes.
BazarekSBrownJM.The evolution of nerve transfers for spinal cord injury. Exp Neurol. 2020,
333: 113426.
2.
BeaulieuJYBlustajnJTeboulF, et al.
Cerebral plasticity in crossed C7 grafts of the brachial plexus: an fMRI study. Microsurgery. 2006;
26: 303–10.
3.
BertelliJA.Nerve versus tendon transfer for radial nerve paralysis reconstruction. J Hand Surg Am. 2020,
45: 418–26.
4.
BiniNLeclercqC.Anatomical study of the deep branch of the ulnar nerve and application to selective neurectomy in the treatment of spasticity of the first web space. Surg Radiol Anat. 2020,
42: 253–8.
BuffenoirKRigoardPFerrand-SorbetsSLapierreF.[Retrospective study of the long-term results of selective peripheral neurotomy for the treatment of spastic upper limb] In French. Neuro-Chirurgie. 2009,
55: Suppl 1: S150–60.
7.
Cambon-BinderALeclercqC.Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity. Surg Radiol Anat. 2015,
37: 341–8.
8.
DecqPShinMCarrillo-RuizJ.Surgery in the peripheral nerves for lower limb spasticity. Oper Tech Neurosurg. 2005,
7: 136–40.
9.
DuanYLuoXGaoXSunC.Cervical selective dorsal rhizotomy for treating spasticity in upper limb neurosurgical way to neurosurgical technique. Interdisciplinary Neurosurgery. 2015,
2: 57–60.
10.
FasanoV.ABarolat-RomanaGIvaldiASguazziA.La radicotomie postérieure fonctionnelle dans le traitement de la spasticité cérébrale. Neurochirurgie, 1976,
22: 23–4.
11.
FengJLiTLvM, et al.
Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and realworld practice guidance. EClinicalMedicine2022,
43: 101258.
12.
FleurenJFMVoermanGEErren-WoltersCVet al.
Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry. 2009,
81: 46.
13.
FoersterO.On the indications and results of the excision of posterior spinal nerve roots in men. Surg Gynecol Obstet. 1913,
16: 463–474.
14.
Fugl-MeyerARJaaskoLLeymanIOlssonSSteglindS.The poststroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med1975,
7: 13–31.
15.
GebreyohanesAMHAhmedAIChoiD.Dorsal root entry zone lesioning for brachial plexus avulsion: a comprehensive literature review. Oper Neurosurg. 2021,
20: 324–33.
GuYD.Functional motor innervation of brachial plexus roots. An intraoperative electrophysiological study. J Hand Surg Br1997,
22: 258–60.
18.
GuYDZhangGMChenDS, et al.
Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg Br. 1992,
17: 518–21.
19.
HelinMBachyMStanchinaCFitoussiF.Pronator teres selective neurectomy in children with cerebral palsy. J Hand Surg Eur. 2018,
43: 879–84.
20.
HillEJRFoxIK.Current best peripheral nerve transfers for spinal cord injury. Plast Reconstr Surg. 2019,
143: 184e–98e.
21.
HodgkinsonIBerardCJindrichMLSindouMMertensPBerardJ.Radicotomie postérieure fonctionnelle chez l’enfant IMC. Résultats á un post-opératoire sur 18 cas. Ann Réadapt Med Phys. 1996,
39: 103–11.
22.
JalouxCBiniNLeclercqC.Nerve transfers in the forearm: potential use in spastic conditions. Surg Radiol Anat. 2022,
44: 1091–9.
23.
KeenanMAETodderudEPHendersonRBotteM.Management of intrinsic spasticity in the hand with phenol injection or neurectomy of the motor branch of the ulnar nerve. J Hand Surg. 1987,
12a: 734–9.
24.
KwakKWKimMSChangCHKimSWKimSH.Surgical results of selective median neurotomy for wrist and finger spasticity. J Korean Neurosurg Soc. 2011,
50: 95–8.
25.
LanceJW.The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 1980,
30: 1303–13.
26.
LeclercqCPerruisseau-CarrierAGrasMPancieraPFulchignoniCFulchignoniM.Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study. J Hand Surg Eur. 2021,
46: 708–16.
27.
MaarrawiJMertensPLuauteJ, et al.
Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg2006,
104: 215–25.
28.
MackinnonSENovakCB.Nerve transfers. New options for reconstruction following nerve injury. Hand Clin. 1999,
15: 643–66.
29.
MikalefPPowerD.The role of neurectomy in the management of spasticity of the upper limb. EFORT Open Rev. 2017,
2: 469–73.
30.
ParotCLeclercqC.Anatomical study of the motor branches of the median nerve to the forearm and guidelines for selective neurectomySurg Radiol Anat. 2016,
38: 597–604.
31.
PaulosRLeclercqC.Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy. Surg Radiol Anat. 2015,
37: 1043–8.
32.
PuligopuAKPurohitAK.Outcome of selective motor fasciculotomy in the treatment of upper limb spasticity. J Pediatr Neurosci. 2011,
6: S118–25.
33.
PurohitAKRajuBSKumarKSMallikarjunKD.Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study. Acta Neurochir (Wien). 1998,
140: 473–8.
34.
ShinDKJungYJHongJCKimMSKimSH.Selective musculocutaneous neurotomy for spastic elbow. J Korean Neurosurg Soc. 2010,
48: 236–9.
35.
SindouM. Etude de la jonction radiculo-médullaire postérieure: La radicellotomie postérieure sélective dans la chirurgie de la douleur. These med, Lyon, 1972.
36.
SindouMAbdennebiBSharkeyP.Microsurgical selective procedures in the peripheral nerves and the posterior root-spinal cord junction for spasticity. Appl Neurophysiol. 1985,
48: 97–104.
37.
SindouMMertensP.Indication for surgery to treat adults with harmful spasticity. In: SindouMAbbottRKeravelY (Eds.) Neurosurgery for spasticity: a multidisciplinary approach.
Wien, New York,
Springer-Verlag, 1991: 211–213.
38.
SindouMMertensP.Selective spinal cord lesioning procedures for spasticity and pain. In: DeletisVShilsJL (Eds.) Neurophysiology in neurosurgery: a modern intraoperative approach.
Cambridge, MA,
Academic Press, 2002: 93–117.
39.
SindouMMilletM.FMortamaisJEysetteM.Results of selective posterior rhizotomy in the treatment of painful and spastic paraplegia secondary to multiple sclerosis. Appl Neurophysiol. 1982,
45: 335–40.
40.
SindouMPSimonFMertensPDecqP.Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst. 2007,
23: 957–70.
41.
SitthinamsuwanBChanvanitkulchaiKPhonwijitLNunta-AreeSKumthornthipWPloypetchT.Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity. Stereotact Funct Neurosurg. 2013,
91: 248–57.
42.
SongcharoenPWongtrakulSMahaisavariyaBSpinnerRJ.Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg Am. 2001,
26: 1058–64.
43.
SteindlerA.Spastic paralysis. In: Reconstructive surgery of the upper extremity.
New York,
Appleton & Co., 1923: 159–86.
44.
StoffelA.Treatment of spastic contractures. Am J Ort Surg. 1912,
10: 611–44.
45.
TardieuGShentoubSDelarueR.A la recherche d’une technique de mesure de la spasticité. Rev Neurol (Paris). 1954,
91: 143–4.
46.
TerzisJKKokkalisZT.Selective contralateral C7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg. 2009,
123: 927–38.
47.
Van ZylNHillBCooperCHahnJGaleaMP.Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series. Lancet. 2019,
394: 565–75.
48.
WaxweilerCRemySMerliniLLeclercqC.Nerve transfer in the spastic upper limb: anatomical feasibility study. Surg Radiol Anat. 2022,
44: 183–90.
49.
WilsonTJ.Novel uses of nerve transfers. Neurotherapeutics. 2019,
16: 26–35.
50.
XuWDHuaXYZhengMXXuJGGuYD.Contralateral C7 nerve root transfer in treatment of cerebral palsy in a child: case report. Microsurgery2011,
31: 404–8.
51.
YongLYWongCHLGastonMLamWL.The role of selective peripheral neurectomy in the treatment of upper limb spasticity. J Hand Surg Asian Pac. 2018,
23: 181–91.
52.
ZhengMXHuaXYFengJT, et al.
Trial of contralateral seventh cervical nerve transfer for spastic arm paralysis. N Engl J Med. 2018,
378: 22–34.
53.
ZiemannUIshiiKBorgheresiA, et al.
Dissociation of the pathways mediating ipsilateral and contralateral motor-evoked potentials in human hand and arm muscles. J Physiol1999,
518: 895–906.
