Nerve bypass surgery for spinal cord reconstruction

Yu-Huan Hsueh; Yen-Wei Li; Kuan-Po Chen; Wen-Liang Chen; Yuan-Kun Tu

doi:10.1016/j.wneu.2024.05.022

Nerve bypass surgery for spinal cord reconstruction

World Neurosurg. 2024 May 10:S1878-8750(24)00775-7. doi: 10.1016/j.wneu.2024.05.022. Online ahead of print.

Authors

Yu-Huan Hsueh¹, Yen-Wei Li², Kuan-Po Chen², Wen-Liang Chen³, Yuan-Kun Tu⁴

Affiliations

¹ Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
² Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
³ College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁴ Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan. Electronic address: ed100130@edah.org.tw.

PMID: 38735563
DOI: 10.1016/j.wneu.2024.05.022

Abstract

Objective: Spinal cord injury (SCI) is a devastating condition that significantly decreases the patient's quality of life. Therefore, treatments that can facilitate nerve regeneration, reduce complications, and increase quality of life are valuable for these patients. In this study, we aimed to assess nerve bypass surgery's feasibility and clinical outcomes by transferring the intercostal nerves (ICNs) into the spinal cord.

Methods: Eight patients with complete thoracic SCI and delayed presentation more than a year after the injury were analyzed retrospectively. All patients underwent nerve bypass surgery with the transfer of two pairs of ICNs from proximal to the injury site to the anterolateral spinal cord, followed by duraplasty with fascia grafting to close the dura.

Results: Six of the eight (75%) patients demonstrated motor and sensory improvements, based on the American Spinal Cord Injury Association score. Three patients demonstrated a limited recovery of motor function that could be independently triggered without ICN initiation. Five patients demonstrated evidence of cerebrospinal fluid (CSF) leakage after surgery; however, only one patient complained of a headache.

Conclusion: Spinal cord bypass surgery is a potential reconstruction method to treat chronic complete thoracic SCI with functional improvements, and is worth further investigation.

Keywords: nerve bypass surgery; reconstruction; spinal cord injury.