Fix that ‘dead’ arm ...by rewiring the nerves to your neck
PATIENTS whose arms are paralysed by disease or injury could have movement restored by pioneering surgery that ‘hijacks’ nerves and reroutes them. The experimental procedure, offered at University Hospitals Birmingham NHS Trust, has already brought what were thought to be ‘dead’ muscles back to life, up to two years after they became immobile.
More than 100 people have had the nerve transfer surgery, including those with spine damage from road accidents, muscle problems due to cancer and spinal arthritis.
This degenerative and progressive joint disease, which is associated with wear and tear and ageing, can affect the spine and lead to arm and leg paralysis in severe cases.
One study has suggested that signs of spinal degeneration linked to arthritis could be present in 90 per cent of over-50s – and increasingly in younger patients.
Singer Robbie Williams, 42, recently admitted to suffering from the condition.
The first symptom is back pain – usually most severe in the morning or after inactivity – and stiffness of the back. Chest and breathing difficulties, and problems with shoulders, hips, arms and knees, are also common.
Physiotherapy, weight loss and anti-inflammatory medications are the first line of treatment.
If the disease is more advanced, fusion of the spine or disc removal or replacement may be an option.
A complication of this type of arthritis is that it results in degenerative discs and tiny pointed outgrowths of bone called spurs – or osteophytes – that can compress and squeeze nerves or the spinal cord. This kind of pressure can cause numbness, tingling, pain and weakness, and in severe instances limb paralysis. In the case of arthritis of the spine in the neck, arm use can be compromised. Surgery to alleviate compressed spinal nerves can lead to similar problems as, though the nerve cells can regenerate, growth is very slow and muscles can permanently atrophy before this happens. Mr Dominic Power, consultant hand and peripheral nerve surgeon explained how the new operation works. He said: ‘In effect, we are rewiring the limbs, by hijacking part of the nerves supplying nearby muscles. We have carried out about 100 of these operations in the past year involving patients with arthritis, degenerative spinal disc disease and spinal fractures.’
So far the procedure has been used to restore movement to both the arms and legs. However, recovery strength in the legs has been less reliable, said Mr Power.
A dozen patients with neck arthritis have had their arm movement restored. In these types of cases, the 45- to 60-minute operation can be carried out under general or regional anaesthetic (a ‘nerve block’), while the patient is awake.
First, a small incision is made on the inner aspect of the arm, exposing the musculocutaneous nerve, which runs from the spinal cord in the neck and governs movement of the biceps and triceps in the upper arm.
Also exposed is the ulnar nerve, which runs along the underside of the arm, across the elbow and into the forearm and hand.
The key to the procedure is that the ulnar nerve is attached to the spinal cord at a lower point than the musculocutaneous nerve, and is often unaffected by compression in the neck.
The surgeon attaches a branch of the ulnar nerve in the arm to the musculocutaneous nerve, allowing signals to ‘bypass’ the damaged area. Over the next six to eight weeks, the newly rerouted nerve grows into the muscle.
‘The first sign that electrical signals are getting through is felt as a tenderness in the muscle, and then it begins twitching,’ explained Mr Power.
‘After that the patient must undergo physiotherapy so they can relearn to use the muscle.’
One of the first such operations was on a 42-year-old motorcyclist injured in a collision with a van. He had eight hours of surgery involving the transfer of six motor nerves, two sensory nerves and a tendon.
‘There was one nerve root still working to his right shoulder and upper arm, so he was able to move his shoulder but nothing else,’ says Mr Power.
‘We were able to transfer eight nerve branches within his arm to rewire his limb. We split the existing nerves and reconnected them.
‘We aimed to give him the ability to reach with his arm and to grasp by restoring sensation and dexterity in his fingers.’
Another patient to benefit is Colin Baker, a retired financial director from West Bromwich. He had a nerve-transfer operation 18 months ago after he lost the use of the right arm due to a tumour pressing on the spine in his neck.
He is now able to move the arm, and even play golf again.
Mr Baker, 80, said: ‘There was pressure on the spinal cord, squeezing the nerves firing the muscles. Mr Power moved the nerves to get the muscles moving again at the wrist and elbow. Now movement has come back and it improves all the time. I wasn’t able to swing a golf club, but now I can again – although my handicap has not improved.’ The Fragile Brain, by Dr Kathleen Taylor Neuroscientist Taylor explains the most recent research into causes of and potential cures for dementia. Oxford University Press, £20