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Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making


Study design

Retrospective cohort study.


To quantify spontaneous upper extremity motor recovery between 6 and 12 months after spinal cord injury (SCI) to help guide timing of nerve transfer surgery to improve upper limb function in cervical SCI.


Nineteen European SCI rehabilitation centers.


Data was extracted from the European Multicenter Study of SCI database for individuals with mid-level cervical SCI (N = 268). Muscle function grades at 6 and 12 months post-SCI were categorized for analysis.


From 6 to 12 months after SCI, spontaneous surgically-relevant recovery was limited. Of all limbs (N = 263) with grade 0–2 elbow extension at 6 months, 4% regained grade 4–5 and 11% regained grade 3 muscle function at 12 months. Of all limbs (N = 380) with grade 0–2 finger flexion at 6 months, 3% regained grade 4–5 and 5% regained grade 3 muscle function at 12 months.


This information supports early (6 month) post-injury surgical consultation and evaluation. With this information, individuals with SCI can more fully engage in preference-based decision-making about surgical intervention versus continued rehabilitation and spontaneous recovery to gain elbow extension and/or hand opening and closing.

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Data availability

The dataset generated and/or analysed during the current study is available from the corresponding author.


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Amanda Miller, MD provided advice on clinically relevant information.


This work was supported by the Department of Defense-W81XWH-17-1-0285 Supporting Patient Decisions about Upper-Extremity Surgery in Cervical SCI (PI: Ida K. Fox). The contents of this work do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Author information

Authors and Affiliations




JD was responsible for study design, extracting and analyzing the data, interpreting the results and writing the report. JDS was responsible for study design, interpreting the results and editing the report. AC was responsible for interpreting the results and providing feedback on the report. MM was responsible for extracting and analyzing the data, and providing feedback on the report. CBN was responsible for study design and providing feedback on the report. IKF was responsible for study design, interpreting the results and writing the report. CC, CK, DO and KCS were responsible for study design and providing feedback on the report. DO, RA, NW, RR, JV, JB and YBK were responsible for data collection and providing feedback on the report.

Corresponding author

Correspondence to Ida K. Fox.

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Dengler, J., Steeves, J.D., Curt, A. et al. Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making. Spinal Cord (2022).

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