Groundbreaking nerve surgery has allowed 13 patients paralysed in car crashes and sporting accidents to use their arms again. Doctors in Australia have successfully reconnected the patients’ limbs to their brains by grafting healthy nerves in the place of damaged ones.
Faced with a lifetime of tetraplegia leaving them unable to move their arms or legs, the patients can now feed themselves, write and even use their phones. Scientists have released fascinating video footage of the patients opening and closing their hands and using their arms.
Although the procedure has been around for years it hasn’t been perfected and isn’t routinely used. The repeated success of the surgery in this study, however, is hailed as an ‘exciting’ breakthrough in what could revolutionise life after devastating spinal cord injuries.
Doctors at Austin Health in Melbourne published a paper outlining the cases of nerve transfer procedures they tried on 16 seriously disabled patients. The people were 27 years old, on average, and were paralysed by spinal injuries in accidents on the road, while playing sport, while diving or from falls.
None were able to register any scores at all in tests measuring their grasp and pinch strength before the surgery, meaning they were unable to use their hands. But, just two years after the life-changing operation, 13 of the patients had enough movement and control in their limbs to successfully carry out the tests.
Two participants didn’t stick with the research for the full two years and one died of causes unrelated to the study, scientists revealed in the medical journal The Lancet. Thanks to the operations and two years of rehab, recovered patients could pick up small objects, brush their teeth and hair, put on make-up, handle money and credit cards and even use tools.
Surgeons managed to restore their muscle function by grafting healthy nerves from above the spinal cord injury onto muscles paralysed beneath the injury. These nerves were taken from small shoulder or arm muscles described by the researchers as ‘spare’, and will not grow back in their original location.
The study leader, reconstructive surgeon Dr. Natasha van Zyl, said: “For people with tetraplegia, improvement in hand function is the single most important goal. “We believe nerve transfer surgery offers an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions.
“[This would allow them] to perform everyday tasks and give them greater independence and the ability to participate more easily in family and work life.” When nerves are damaged by injury or disease they lose their ability to transmit electrical signals from the brain, which tell muscles to move.
In serious injuries, which sever, or snap the nerve – which has a structure like an electrical wire – it will never grow back, leading to muscles being paralysed forever. How does nerve transfer surgery work? Nerve transfer surgery works by replacing nerves damaged in an injury with healthy ones from elsewhere in the body.
When someone is injured in a way that disturbs, damages or completely breaks their nerves, they may lose the ability to control parts of the body, leading to paralysis. This is because the nerves, of which there are around 100billion in the body, act like electric wires carrying signals from the brain to the body. When these are blocked the muscles are paralysed and the skin may lose its feeling.
In nerve transfer surgery, working nerves taken from areas unaffected by the injury – above the damage to the spinal cord in a spinal injury, for example – are removed intact and grafted elsewhere in the body. The healthy nerves are then reconnected to a functioning part of the spinal cord and to the paralysed muscle, essentially making a bypass around the damaged nerve.
This means signals to and from the brain can continue to flow and the muscles are brought back to life. After the surgery it may take months for the nerves to grow properly into the muscle – they tend to grow at a maximum of 2mm to 5mm per day – and even years for the muscles to get back to a useful level of strength.
The surgery should be done within six to 12 months of injury because the longer a patient waits the more chance their muscles have to weaken and waste away, making the road to recovery longer. The spinal cord – a thick bundle of nerves running through the bony spinal column – is the root of all the body’s nerves, which is what makes spinal injuries so traumatic.
The researchers say there are up to 500,000 spinal cord injuries per year around the world, with more than half resulting in tetraplegia – neck-down paralysis. Each of the Melbourne patients had their surgery within 18 months of their original injury. Longer waits leave more time for muscles to weaken and waste away.
In 10 of the people, surgeons performed both nerve and tendon transfers, and the remaining three had only nerve grafts. The research found nerve transfers were able to restore fine motor skills, allowing patients to grasp and pick things up.
While tendon transfers, which involve moving a working muscle and tendon to the site of a paralysed one, were better for bringing back strength for lifting. Dr. van Zyl and her team said nerve transfers were ‘attractive’ because they could revive the correct muscles and could bring back more than one at once.
Tendon grafts, in contrast, could only replace muscles on a one-for-one basis and the limb would have to adapt to using a muscle developed elsewhere in the body. One unnamed patient who had both surgeries was filmed using his newly revived arms to pick up a water bottle with one hand and shake it vigorously with the other, showing off the different skills.
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