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  • Review Article
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Nerve transfers to anterior interosseous nerve for restoration of finger flexion in spinal cord and brachial plexus injury: a systematic Review and individual-patient-data meta-analysis

Spinal Cord volume 63, pages 127–134 (2025)Cite this article

Subjects

Abstract

Study Design

Systematic review and meta-analysis.

Objectives

Cervical spinal cord injury (SCI) and brachial plexus injury (BPI) can result in hand paralysis. Reconstruction of hand motion is associated with improved functionality and quality of life. We synthesized the outcomes of finger and thumb flexion after various nerve transfers to the anterior interosseous nerve (AIN).

Methods

A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Successful finger and thumb flexion recovery was defined as Medical research council (MRC) grade ≥3.

Results

In total, 23 studies with 99 patients and 120 nerve transfers to the AIN were performed. The mean interval from injury to surgery was 12.8 months and mean follow-up duration was 24 months. Overall, 81/120 (67.5%) and 68/102 (66.7%) hands achieved successful finger and thumb flexion recovery, respectively. Individual-patient-data were available for 94 nerve transfers. Type of injury (SCI vs BPI/peripheral) did not affect finger flexion outcomes (OR 1.92, 95%CI 0.74–5.0, p = 0.17). On multivariate analysis adjusted for mechanism of injury, timing of injury to surgery and duration of follow-up, utilization of the brachioradialis (BR) branch (25%, 1/4, OR 0.01, 95%CI 0.0006–0.44, p = 0.01) and brachialis (BA) branch (59%, 30/51, OR 0.06, 95%CI 0.006–0.68, p = 0.02) as donors, were associated with statistically significant lower odds of successful finger flexion recovery compared to extensor carpi radialis brevis (ECRB) use (95%, 19/20).

Conclusions

Similar outcomes were observed with SCI and BPI/peripheral type injuries. ECRB utilization as a donor was superior to BA or BR branch in terms of successful finger flexion recovery.

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Data availability

additional data are available from the corresponding author on reasonable request.

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Acknowledgements

Dom D’Andrea, BS for medical illustration of Fig. 3.

Author information

Author notes

  1. These authors contributed equally: Pavlos Texakalidis, Stavros Matsoukas.

Authors and Affiliations

  1. Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL, USA

    Pavlos Texakalidis, Nader S. Dahdaleh & Kevin Swong

  2. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Stavros Matsoukas

  3. Department of Neurosurgery, University of California San Diego, San Diego, CA, USA

    Nikhil Murthy

  4. Physical Medicine and Rehabilitation Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Adenike A. Adewuyi & Colin K. Franz

  5. Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA

    Colin K. Franz

  6. Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Colin K. Franz

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  1. Pavlos Texakalidis
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  7. Kevin Swong
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Contributions

PT was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, performing statistical analysis, drafting manuscript. SM was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, reviewing manuscript. NM was responsible for analyzing and interpreting data, critical review of manuscript and providing feedback. AA was responsible for analyzing and interpreting data, critical review of manuscript and providing feedback. ND was responsible for analyzing and interpreting data, critical review of manuscript and providing feedback. CF was responsible for analyzing and interpreting data, critical review of manuscript and providing feedback. KS was responsible for analyzing and interpreting data, critical review of manuscript and providing feedback.

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Correspondence to Pavlos Texakalidis.

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Texakalidis, P., Matsoukas, S., Murthy, N. et al. Nerve transfers to anterior interosseous nerve for restoration of finger flexion in spinal cord and brachial plexus injury: a systematic Review and individual-patient-data meta-analysis. Spinal Cord 63, 127–134 (2025). https://doi.org/10.1038/s41393-025-01066-0

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