Contralateral C7 Nerve Transfer in the Treatment of Adult Brachial Plexus Injuries and Spastic Hemiplegia

Contralateral C7 nerve root transfer surgery, one of the most important surgical methods in treating brachial plexus avulsion injury, was first reported by Dr. Gu in 1986 and has been extended to treat hemiplegic paralysis. In Part I, we introduced the brief history of contralateral C7 nerve root transfer for adult brachial plexus injuries and the surgical anatomy of C7 nerve, together with the surgery procedures, which consisted of the application of sural nerve graft and the new route for direct neurorrhaphy. The indications, selection of recipient nerves, postoperative monitoring, potential complications, and factors that may affect the results were also described. In Part II, we focused on the application of contralateral C7 nerve transfer in treating spastic hemiplegia. The mechanism, clinical trials, indications, and exclusions for the treatment of spastic hemiplegia were all introduced. The latest surgical technique of creating a trans longus colli, prespinal route and progresses of further applying the concept to the hemiplegic lower extremity were also described. To conclude, contralateral C7 transfer is a complex procedure referable to cerebral plasticity, and the final results could be attributed to involvement of both peripheral regeneration and brain reorganization.