To preliminarily investigate the surgical method and clinical effect of contralateral seventh cervical nerve transfer in the treatment of central spastic paralysis in the contralateral upper limb.

A retrospective analysis was conducted on six patients with central spastic paralysis in unilateral upper limb underwent contralateral seventh cervical nerve transfer at Department of Neurosurgery, Affiliated Hospital of Binzhou Medical University from November 2018 to March 2019. Postoperative comprehensive rehabilitation treatment was administered for all patients. The change of motor function were evaluated based on Fugl-Meyer (FM) motor function rating scale and Brunnstrom functional recovery stage table. The change of muscle tension was evaluated based on modified Ashworth grading standard (MAS), and motor evoked potential (MEP) was used to evaluate the growth of transferred nerve.

None of the 6 patients had vascular or nerve injury during operation. Transient weakness and numbness to varying degrees were reported in the upper limb on the healthy side, and both recovered at 1 to 3 months post operation. Postoperative follow-up duration was 17.3±1.4 months (15-19 months). The postoperative (at 1 month and 1 year post surgery) scores of FM motor function rating scale and Brunnstrom functional recovery stage table both gradually increased compared with preoperative scores and the differences were statistically significant(all P<0.01). Among the 6 patients, preoperative MEP examination showed no waveforms on the affected side in 5 patients, and waveforms could be induced in all at 1 year post surgery. In 1 patient, the latency and amplitude of preoperative MEP were 29.7 ms and 0.8 mV respectively, and those at 1 year post operation were 22.0 ms and 1.9 mV respectively.

Preliminary clinical observation has suggested that the contralateral seventh cervical nerve transfer is effective with few complications in the treatment of central spastic upper limb paralysis.

Hemiplegia; Central nervous system; Spasm; Upper extremity; Contralateral seventh cervial nerve transfer