Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope
Authors: Xiang Chengwei , Shi Haiping , Li Weimin , Long Yong 
Published: July 2024

Abstract

Objective: To investigate the clinical effectiveness and prognosis of contralateral C7 nerve transfer via the anterior cervical approach in the treatment of central hemiplegia.
Method: The clinical data of patients with central hemiplegia admitted to the Neurosurgery Department of Suining Central Hospital between 2022 and 2023 were retrospectively analyzed. All cases were categorized into an experimental group and a control group. The experimental group comprised patients who underwent cervical 7 nerve transfer surgery; The control group included patients who received physical rehabilitation therapy during the same period and matched the age and general conditions of the surgical patients. The rehabilitation progress of the surgical and physical rehabilitation groups was compared at three time points: before treatment, six months post-treatment, and twelve months post-treatment. Indicators collected included: Modified Ashworth Scale (MAS) grades to assess muscle tone in the affected limbs; Fugl-Meyer Motor Function Assessment (FMA) scores to evaluate upper limb motor function; Berg Balance Scale (BBS) scores to assess balance function; and Boston Diagnostic Aphasia Examination (BDAE) grades to evaluate language function. Statistical Analysis: Data were analyzed using SPSS 25.0 statistical software. Repeated measures analysis of variance was applied for the Fugl–Meyer, BDAE, and BBS scores, while independent sample t-tests were used for comparing the two groups at the same time point. Bonferroni tests were applied for pair-wise comparisons between the same group at different time points. Mann-Whitney tests were used for the MAS scores. Differences were considered statistically significant with P<0.05. All methods were in accordance with the relevant guidelines and regulations of Suining Central Hospital
Result:All surgical patients successfully completed their procedures, with an average duration of approximately 6 hours. Postoperatively, the unaffected limbs exhibited varying degrees of pain, yet their movement remained within normal limits. There were no complications including wound infections or bleeding in the surgical areas. The Fugl-Meyer assessment scale revealed significant improvements in motor function for both the surgical and physical rehabilitation groups, with the surgical group outperforming the physical rehabilitation group, especially in terms of upper limb stiffness and movement (p＞0.05);
Conclusion: This study demonstrates that CC7 nerve cross transfer surgery effectively, safely, and sustainably improves spasticity, balance, and upper limb motor function in patients with unilateral spastic arm paralysis, without significant contralateral limb dysfunction or serious complications. The high clinical efficacy and safety of the procedure provide a basis for expanding its indications to a broader population of hemiplegic patients. The primary limitation of this study is its retrospective design, with selection biases and potential confounding factors persisting even after closely matching key characteristics. Consequently, the findings should be interpreted with caution. Additional multicenter studies are warranted to further assess its effectiveness and safety.