Paralysed man can move hand to feed himself again after his nerves rewired in pioneering surgery
Patient, now 71, became a quadraplegic in a car crash four years agoHealthy nerves were reconnected independently of spinal cord
17:47 GMT, 15 May 2012
A paralysed man has regained the use of his hand after he had a pioneering operation to bypass damage to his spinal cord.
The 71-year-old patient injured the lowest bone in his neck in a car crash in June 2008.
The damage to the C7 vertebra left him without the use of his legs and only limited shoulder, elbow and wrist function.
Returning the use of the hand: The patient can now pinch his fingers and feed himself
He also lost the use of his hand because while the nerve circuit in his hand was intact, the connection between his brain and digits had been lost.
Surgeons at Washington University School of Medicine in St Louis restored this link by rerouting working nerves in his upper arm.
The patient can now pinch his thumb and index fingers together using nerves that once told his brain to bend at the elbow.
Senior researcher Dr Ida K Fox said: 'This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is.
'Instead, we go out to where we know things work – in this case the elbow – so that we can borrow nerves there and reroute them to give hand function.'
The patient underwent intense physiotherapy so his brain could understand how his nerves now worked
The successful operation means the patient can now feed himself and even write.
'Many times these patients say they would like to be able to do very
simple things,' Dr Fox said.
'If we can restore the ability to
pinch, between thumb and index finger, it can return some very basic
The surgery was developed and performed by Dr
Susan E. Mackinnon.
Specialising in injuries to peripheral nerves, she has pioneered similar
surgeries to return function to injured arms and legs.
She said hand function was not restored straight away and that the patient had to undergo intensive physical therapy to retrain the brain to understand how the role of the nerves had changed.
Dr Mackinnon said another patient with a similar injury could be treated at any time as their case study received the surgery two years after his accident.
Surgeons connect a nerve that signals to the brain with a nerve that signals to the hand
He said nerves run out from the spinal cord 'like spaghetti' to the tips of the fingers and toes.
Nerves remained healthy as they were still connected to the spinal cord, however the nerves could no longer 'talk' to the brain because the spinal cord injury blocks them.
To detour around the block in this patient’s C7 spinal cord injury
and return hand function below the level of the injury, Mackinnon
operated in the upper arms.
There, the working nerves that connect above
the injury and the non-working nerves that connect below the injury run
parallel to each other, making it possible to tap into a functional
nerve and direct those signals to a non-functional neighbour.
In this case, Mackinnon took a non-working nerve that controls the
ability to pinch and plugged it into a working nerve that drives one of
two muscles that flex the elbow.
After the surgery, the bicep still
flexes the elbow, but a second muscle, called the brachialis, that used
to also provide elbow flexion, now bends the thumb and index finger.
'This is not a particularly expensive or overly complex surgery,' Dr
'It’s not a hand or a face transplant, for example. It’s
something we would like other surgeons around the country to do.'