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Case Reports
. 2021 Mar 26;100(12):e25061.
doi: 10.1097/MD.0000000000025061.

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis: A case report

Jingyu Guan  1 , Jun Lin  1 , Xueqing Guan  2 , Qiang Jin  3 , Wenchuan Zhang  4
Affiliations
Case Reports

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis: A case report

Jingyu Guan et al. Medicine (Baltimore). .

Abstract

Introduction: C7 nerve transfer alone can improve upper limb motor function and partial spasticity. Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. We propose a novel possible improvement of contralateral C7 (CC7) nerve transfer through the posterior vertebral approach, which was combined with SPR of the affected cervical nerve.

Patient concerns: A 33-year-old male patient presented with cerebral hemorrhage of the left basal ganglia, paralysis of the right limbs, and hypesthesia 8 months earlier. The dysfunction of the affected hand was already present at admission. The patient reported a previous history of hypertension for several years and oral antihypertensive drugs, and blood pressure was controlled within a normal range.

Diagnosis: Central upper limb spastic paralysis. The muscle strength of the right lower limb was grade IV. The Fugl-Meyer score of the right upper limb was 7 points, and the modified Ashworth score was 10.

Interventions: The patient underwent CC7 transfer and SPR.

Outcomes: The patient successfully underwent CC7 transfer and SPR without complications. On the day after surgery, the left upper limb motions were normal. The Fugl-Meyer score was 9, and the modified Ashworth score of the right upper limb was 2.

Conclusions: CC7 nerve transfer through the posterior vertebral approach combined with SPR of the affected cervical nerve can possibly improve the surgical outcomes of selected patients with upper limb motor dysfunction and partial spasticity. This method has not been reported in the literature before, and additional studies are necessary.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A: Preoperative head computed tomography (CT) scan revealing a softening lesion of the left basal ganglia. B: Diffusion tensor imaging (DTI) of the head showing a significant decrease in fibers in the left basal ganglia. C: Magnetic resonance imaging (MRI) scan of the brachial plexus, revealing normal bilateral brachial plexuses. D: Cutting and measuring the CC7 nerve. E: Tension-free anastomosis between the left C7 nerve and the right one. F: Exploring the posterior root of the C6 nerve.
See this image and copyright information in PMC

References

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