gms | German Medical Science

Objectives/Interrogation: Contralateral C7 nerve transfer has been successfully applied to improve upper-limb motor function for patients who had arm paresis that had ceased to improve after rehabilitation. Similar strategy possibly exists in the lower limb. This study was designed to explore a new procedure for unilateral lower limb dysfunction due to stroke and traumatic spinal cord injury.

Methods: Four patients were enrolled in the study. The first suffered from permanent muscle weakness in his left leg after right cerebral infarction. The second had spasticity and hemiplegia in both upper and lower limbs on the right after a left cerebral hemorrhage. The other 2 patients are with incomplete lower limb paraplegia due to traumatic spinal cord injury caused by spinal fracture. After spinal canal decompression procedure, these two patients mainly manifested as unilateral lower limb dysfunctions. All four patients underwent contralateral lumbar to sacral nerve transfer to improve lower-limb motor function. The procedure mainly consists of transferring 50% of the proximal contralateral lumbar ventral L5 to 50% of the distal ventral S1 nerve (or S1+S2). Selective posterior rhizotomy was performed together in 1 patient with spastic lower limb paralysis. Motor function of lower limb was assessed preoperatively and postoperatively.

Results and Conclusions: 20 months after surgery, all these patients experienced significant improvement in ambulatory status. Motor function of unaffected lower limb was not impaired by transferring 50% of the proximal lumbar ventral L5.

In conclusion, this pilot study demonstrates the possible benefits of contralateral lumbar to sacral nerve transfer for hemiplegic patients. This surgical approach could provide a new means for lower-limb motor functional recovery. Further research, including long-term follow-up and a randomized controlled trial, is required.