Clinical Sciences/Health Conditions
Marlene Alejandra Rodríguez Barragán, MD, MSc (she/her/hers)
Neurological Rehabilitation Specialist
Instituto Nacional de Rehabilitación
Mexico, Distrito Federal, Mexico
Jimena Quinzaños, MD, PhD (she/her/hers)
Head of Neurologic Rehabilitation Department
instituto nacional de rehabilitación
mexico city, Distrito Federal, Mexico
Aída Barrera Ortíz, MD
Neurological Rehabilitation Specialist
Instituto Nacional de Rehabilitación
Mexico, Distrito Federal, Mexico
Julio Macías Gallardo, PhD
Clinica Neurophysiology
Instituto Nacional de Rehabilitación
Mexico, Distrito Federal, Mexico
Virginia Bueyes, Eng, Master
Researcher at Motion Analysis Laboratory
instituto nacional de rehabilitación
mexico city, Distrito Federal, Mexico
SCI results in severe functional limitations, particularly affecting UL function in those with cervical injuries such as tetraplegia. Recovery is typically constrained by neuronal plasticity, which plateaus one-year post-injury, and the complexity increases with TM. While conventional therapies exist, surgical options like nerve and tendon transfers show promise for restoring UL function.
Case Description:
A 21-year-old male was diagnosed with extensive transverse myelitis (TM) from C4 to T2 an SCI AIS A scale, neurological level C4. The injury progressed to neurological level C6, with no improvement 13 months port-injury. He was considered a candidate for nerve transfers to improve upper limb (UL) function. Multidisciplinary management was provided. The patient was evaluated every 3 months post-surgery to measure clinical, functional, and quality-of-life changes.
Discussions:
This case presents the established goals and the progress achieved in an individual with non-traumatic due to extensive TM following nerve transfer surgery to restore upper limb function, a treatment that commonly would not be used for an extensive SCI.
A particular challenge in extensive TM is that potential donor nerves can often show evidence of injury due to the diffuse nature of the inflammation. In current clinical practice, there are no changes to the treatment windows for nerve transfer in patients with myelitis. However, managing patient expectations is crucial. A warning to take into account is that postoperative strength improvement is a slow but prolonged process that may extend over several years. The prognosis depends on the underlying cause of the myelitis and the degree of initial damage.
Conclusions:
This case presents the established goals and the progress achieved in an individual with non-traumatic due to extensive TM following nerve transfer surgery to restore upper limb function, a treatment that commonly would not be used for an extensive SCI.
