Surgeons in the United States have for the first time restored movement to the previously paralysed hand of a 71-year-old man injured in a car incident by essentially splicing a defunct nerve with a working one in his upper arm, according to a report released yesterday in the Journal of Neurosurgery.
The study describes the gradual return of sensation and movement to the man’s hand after months of physical therapy that followed the procedure which involved taking a moribund nerve that controls the pinching of the thumb and forefinger and connecting to a nerve in the upper arm that was still live.
The man is now at the point where he can feed himself bite sized portions of food and write with help. He was paralysed from the waist down after a car accident a few years ago. The study suggests that the procedure could be replicated in other patients, depending on where exactly they have suffered spinal chord damage.
“This is not a particularly expensive or overly complex surgery,” said senior author Susan Mackinnon, who developed and performed the surgery. “It’s not a hand or a face transplant, for example. It's something we would like other surgeons around the country to do.” Ms Mackinnon is head of the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine in St Louis, Missouri.
After the crash, the patient was considered a quadriplegic. Damage to the lowest bone in his neck, the C7 vertebra meant he was left unable to move from the waist down and while he could still move his shoulders, elbows and wrists all function in his hands was gone.
The nerve that has now been connected to his hand used to be for bending the elbow. By connecting with it, the surgeons were able to bypass the damaged spinal chord entirely.
“This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is,” said surgeon Ida Fox, assistant professor of plastic and reconstructive surgery at Washington University. “Instead, we go out to where we know things work -in this case the elbow - so that we can borrow nerves there and reroute them to give hand function.”
The success of the procedure may surprise in the reconstructive field of medicine because of the age of the patient. Generally nerve regeneration can be hardest to achieve in people over a certain age.