Utilization Rates of Nerve and Tendon Transfer to Improve Upper Limb Function in Cervical Spinal Cord Injury
Jana Dengler, MD1, Maytal Perlman, BKI2 and Michelle Jennett, HBA2, (1)University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (2)University of Toronto, Toronto, ON, Canada
Introduction: The loss of upper limb function in cervical spinal cord injury (SCI), tetraplegia, contributes to substantial disability and loss of independence, and ultimately restricts participation and quality of life. People living with tetraplegia have identified improvement of upper limb function as a top priority. Nerve transfer and tendon transfer surgery are currently the only successful, widely translatable, safe, and affordable treatments to improve upper limb function in tetraplegia. Unfortunately, nerve and tendon transfer remain under-utilized in this population worldwide. The purpose of this study was to assess the utilization of nerve and tendon transfer surgery for individuals with tetraplegia in Canada over the last 16 years.
Materials and Methods: Data from the Canadian Institute for Health Information's Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the number of nerve transfer and tendon transfer procedures performed in cervical SCI in Canada between 2004/05 and 2019/20. Cases were identified using relevant ICD-10-CA codes for cervical SCI and relevant Canadian Classification of Intervention codes for nerve transfers and tendon transfers in the upper extremity. Data on sex, age at time of procedure, province, and length of hospital stay were also recorded.
Results: An estimated 21,000 people with traumatic tetraplegia are living in Canada, with 787 new injuries each year. Between 2004/05 and 2019/20, a total of 85 nerve transfer procedures (81% male, mean age 38.2 years) and 61 tendon transfer procedures (78% male, mean age 45 years) were performed. Using a conservative estimate of 50% eligibility, an average of 1.35% of individuals underwent nerve transfer and 0.97% of individuals underwent tendon transfer each year. The number of nerve transfers has increased over time (2004-2009, n=<10; 2010-2015, n=27; 2016-2019, n=49,) and the number of tendon transfers remained relatively constant. Both nerve and tendon transfers were performed as day surgery or with a single overnight stay. The number of procedures were highest in Ontario (n=166) and British Columbia (n=119).
Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb function in Canadians with tetraplegia remains very low, highlighting a substantial gap in care for this vulnerable population. Identification of the barriers that prevent access to care is required to develop and promote best practice guidelines for delivering upper limb surgical care.
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