Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

Patient: Female, 45-year-old Final Diagnosis: The patient could fully abduct her left shoulder to 170°, and the LUE functions were restored Symptoms: Complete paralysis of the left upper extremity Clinical Procedure: — Specialty: Neurosurgery • Plastic Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Cervical spine deformities can occur because of genetic, congenital, inflammatory, degenerative, or iatrogenic causes. CASE REPORT: We report a 45-year-old woman who presented to our clinic with complete paralysis of the left upper extremity 5 months after C4–C6 discectomy and fusion surgery. The electrodiagnostic and EMG reports 3 months after her previous surgery revealed left C5–C7 polyradiculopathy involving the upper trunk, lateral and posterior cords, and atrophy of the left deltoids, triceps, and biceps muscles. She underwent the following nerve transfer procedures with the senior author (RKN): The median nerve fascicles were transferred to the biceps and brachialis branches of the musculocutaneous nerve. Radial nerve triceps branches were transferred to the deltoid and teres minor branches of the axillary nerve. The patient could fully abduct her left shoulder to 170°, and the LUE functions were restored to nearly normal 17 months after the surgery. CONCLUSIONS: Neurolysis combined with nerve transfer might be the most effective treatment for cervical spinal root injuries. Advances in peripheral nerve rewiring, transcranial magnetic stimulation, brain-computer interface robotic technologies, and emerging rehabilitation will undoubtedly increase the possibility of reviving the extremities in patients with central pathology by restoring the descending motor signals through the residual neural network connections.