Anatomical study and clinical application of posterior cervical 7 nerve transfer in the treatment of central upper limb spastic paralysis
Yan Zhengcun1, Zhang Hengzhu1, Guan Jingyu2, Gu Jiaxiang3, Liu Hongjun3, Meng Zhaoxiang4, Luo Wenmiao1, Wang Xiaodong1, Wang Xingdong1, Wei Min1
1Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; 2Department of Neurosurgery, Northern Theater General Hospital, Shenyang 110000, China; 3Department of Hand Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; 4Department of Rehabilitation, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
Abstract：Objective To investigate the anatomical basis and clinical effect of contralateral cervical 7 (C7) nerve transfer via posterior cervical approach in the treatment of central upper limb spastic paralysis. Methods Five fresh head and neck anatomical specimens, including three males and two females aged 56-72 years with an average age of 66 years, were selected to simulate posterior C7 nerve transfer. The left C7 nerve was separated and exposed under a microscope. The shortest distance in a straight line between the C7 nerve and the inner edge of the clavicle was measured. Then, the left C7 nerve root was cut off for standby. The laminae and spinous processes of C6 and C7 were exposed through the posterior cervical approach. A small hole was ground on the inner rear wall of the bilateral intervertebral foramen, the left C7 nerve was led out, and the right C7 nerve was cutoff for standby. The led out C7 nerve was sewn to the distal end of the right C7 nerve through the interspace between the spinous processes. Then, the length of the C7 nerve led out through the posterior cervical approach and the shortest distance of the C7 nerve transfer were measured, The minimum width of the posterior wall of the intervertebral foramen and the ratio to the facet joint of the posterior wall of the intervertebral foramen were also measured. The clinical data of a case of posterior C7 nerve transfer surgery through posterior cervical approach, which was carried out by Jiangsu Subei People's Hospital from November 2019 to December 2020, were retrospectively analyzed. The patient was a 45-year-old male who was clinically diagnosed with spastic paralysis of the central upper limb after parietal hemorrhage. The muscle strength and muscle tension of the right upper limb were grades 0 and 3, respectively, and the muscle strength and muscle tension of the right lower limb were grades 2 and 1, respectively. Posterior C7 nerve transfer surgery was performed. The muscle tension and muscle strength between the healthy side and the affected side postoperatively were compared. Results The C7 nerve was located in the deep part of the middle point of the clavicle. The shortest distance in a straight line between the C7 nerve root and the medial edge of the clavicle was 1.8-2.5 (2.1±0.4) cm. The length of the C7 nerve from the posterior cervical approach was 6.6-7.4 (7.1±0.4) cm. The shortest distance of nerve transfer was 3.9-4.3 (4.0±0.2) cm. The minimum width of the grinding of the posterior wall of the intervertebral foramen was 4.6-5.3 (4.8±0.3) mm, The length of facet joint on the posterior wall of intervertebral foramen was 12.0-15.8 (13.6±0.5) mm; The ratio of grinding distance of posterior wall of intervertebral foramen to facet joint was 33.6%-38.2% (35.8%±0.4%). Clinically, one patient with central upper limb paralysis underwent C7 nerve transfer surgery via posterior cervical approach. After operation, the muscle strength of the healthy side of the upper limb was normal and accompanied by sensory numbness. After 1 month, it completely recovered, the spasm symptoms of the affected side of the upper limb were considerably relieved, Muscle strength was level 0, and muscle tension was level 1. The patients were followed up for 12 months. At the last follow-up, the sensory and motor functions, muscle strength, and muscle tension of the healthy side were normal. The muscle strength of the affected side was restored to grade 1, muscle tension was grade 1, sensory function was normal, and motor function was in recovery. Conclusion The position of the C7 nerve is relatively constant, the posterior cervical anatomy is relatively simple, and the nerve transfer distance is short. Posterior C7 nerve transfer can be used to treat the central upper limb spastic paralysis.
严正村, 张恒柱, 关靖宇, 顾加祥, 刘宏君, 孟兆祥, 罗文苗, 王晓东, 王杏东, 魏民. 经颈椎后路健侧颈7神经移位手术治疗中枢性上肢痉挛性瘫痪的解剖研究及临床应用[J]. 中华解剖与临床杂志, 2022, 27(3): 138-143.
Yan Zhengcun, Zhang Hengzhu, Guan Jingyu, Gu Jiaxiang, Liu Hongjun, Meng Zhaoxiang, Luo Wenmiao, Wang Xiaodong, Wang Xingdong, Wei Min. Anatomical study and clinical application of posterior cervical 7 nerve transfer in the treatment of central upper limb spastic paralysis. Chinese Journal of Anatomy and Clinics, 2022, 27(3): 138-143.
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