Doctors are finding incredible ways to give permanently injured children a better future. That includes a surgical procedure that has paralyzed kids on the move again.
After a car crash left him paralyzed seven years ago, Steven Jackson needed help doing simple, everyday tasks like, "feeding myself, brushing my teeth, like combing my hair.”
Today, the 20-year-old enjoys the sweet taste of independence thanks to a surgery that improved the motion he had left.
Dr. Scott Kozin says, "Fortunately, when you are paralyzed, most individuals retain some motion.”
Dr. Kozin did a procedure called a ‘tendon transfer’ at Shriners Hospital for Children in Philadelphia.
Dr. Kozin says, "In Steven’s case, we transferred the biceps with its tendon to the back of the elbow to allow his elbow to be straightened. And then the other two muscles still were able to perform elbow flexion.”
A tendon is a strong cord that connects muscle to bone. Dr. Kozin focused on the three muscles in Steven's arm that still allowed him to bend his elbow.
The doctor says, "Even though we would think we need three muscles to bend our elbow, we probably only need one or two of them. So, in that case, we could transfer one of those muscles and tendon that’s working to do another function.”
Selecting the right tendon is important because the muscle will lose strength after the transfer.
“You want to transfer obviously a strong tendon so you have a strong function," the surgeon says. "You don’t want to transfer a weak tendon.”
Thanks to the surgery, Steven says, "I can brush my teeth, comb my hair, wash myself. I think just, uh, the little thing that you can do for yourself makes you feel much better.”
Dr. Kozin has performed tendon transfer surgery on kids as young as three. The tendon grows with the child. Other Shriners Hospitals that do this highly specialized procedure are in Chicago and Sacramento.
Fast Facts:Approximately 250,000 Americans are living with a spinal cord injury. Roughly 11,000 new cases occur each year.
Fewer than one percent of people with spinal cord injuries experience a complete recovery.
Generally, the higher up the area of injury in the spine, the greater the loss of function. Some physicians are using a specialized technique, called tendon transfer, to allow functioning nerves to take the place of those that have lost their connection with the brain. The technique can enable some patients to regain lost function in the limbs and provide some sense of independence.
The Spinal Cord
The spinal cord is the network of nerve fibers that serves as a communication conduit for nerve signals between the brain and the rest of the body. It is about 18 inches long and goes from the brain down to the buttocks.
The spinal cord is encased by the spinal column – a long bone with a series of ladder-like rungs, called vertebrae. It’s divided into sections. Starting from the top of the neck down, there are eight cervical segments, 12 thoracic segments, 5 lumbar segments and 5 sacral segments. The segments are numbered starting at the top of the spine (from C-1 to C-7, T-1 to T-12, L-1 to L-5 and S-1 to S-5).
Spinal Cord Injuries
When the spinal cord is injured, communication between the brain and the section of the spinal cord at and below the point of injury is disrupted. The higher up the spine the injury, the greater the loss of function. Injuries in the cervical spine usually cause tetraplegia (formerly known as quadriplegia). Patients with an injury above the C-4 segment usually require a ventilator to breathe. Those with C-5 injuries often have some sensation/movement in the shoulders and upper arms, but no control of the hand or wrist. A person with a C-6 injury may have wrist function, but no hand control/sensation. Spinal cord injuries in the thoracic area and below generally cause paraplegia, or loss of feeling/movement in the lower body and legs.
According to the National Spinal Cord Injury Information Network, roughly 250,000 Americans are living with a spinal cord injury. About 11,000 new cases occur each year. Spinal cord injuries are more common in males (79.6 percent of cases) and young adults (average age at the time of injury is 37.6).
The most common cause of spinal cord injury is a motor vehicle accident (causing about 47.5 percent of cases). Falls are the second leading cause (22.9 percent of cases), followed by acts of violence (13.8 percent – mainly from gunshots) and recreational sports (8.9 percent of cases).
Helping Patients Regain Function: Tendon Transfers
After a spinal cord injury, less than one percent of patients experience a full neurological recovery. Some people are dependent upon others for daily care. Patients who have limited use of their hands may not even be able to pick up a fork, hold a pencil or turn a doorknob.
When a spinal cord injury occurs, the nerve signals that control muscle contraction may be lost, causing the muscle to become paralyzed. Many patients retain some nerve function – though it may not be enough to sustain mobility. Now, some doctors are taking advantage of those functioning nerves to find new ways to provide mobility in an area of the body, like the hand or wrist. The procedure is called a tendon transfer.
Tendons are strong, fibrous cords of tissue that connect muscle to bone. When the muscle contracts, it pulls the tendon and the attached bone, causing movement. In the arm, there are more than 40 muscles below the elbow that control various movements. If there is some remaining nerve function to the muscles, doctors can re-route tendons to help a patient gain a greater degree of motor control.
Prior to the surgery, patients receive a thorough evaluation to determine which muscles and tendons are functioning. Once doctors determine which muscles are healthy (i.e., the nerve signals are still working), surgery can be planned.
In the operating room, doctors locate one of the tendons attached to a healthy muscle. The tendon is cut from the bone, leaving the other end attached to the muscle. The free end of the tendon is moved and sewn onto a different place on the bone or onto another tendon. When the muscle fires, it pulls on the tendon and enables control over a previously lost movement. In other words, the healthy muscle is now performing the action of the paralyzed muscle. Depending on the needs and health of the muscles, several tendons may be transferred.
After surgery, the affected area of the limb is placed in a cast for three to four weeks to allow for healing. Patients then require physical therapy to learn how to adapt to the placement of the tendon and strengthen the muscle.
Tendon transfer can make a big difference in the lives of many people with spinal cord injuries, enabling them to have wrist control and use of the thumb to grasp and pick up objects. In many cases, it allows them to have more independence. The surgery can be done on people of all ages, including children. Some risks of the procedure can include scar formation, infection and adverse effects of anesthesia. After surgery, patients must carefully follow the physician’s recommendations for therapy. If movement begins too early (or is initially too aggressive), the tendon may rupture (tear). Initiating movement too late can lead to scar formation and stiffness.
Web ResourcesAmerican Society for Surgery of the Hand Web site
For information on spinal cord injury or tendon transfer:
Christopher and Dana Reeve Paralysis Resource Center Web site
The National Institute of Neurological Disorders and Stroke Web site
The National Spinal Cord Injury Association Web site