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Lin et al. Plast Aesthet Res 2024;11:8 Plastic and
DOI: 10.20517/2347-9264.2023.57
Aesthetic Research

Review Open Access

Review of outcomes measures used to evaluate
upper extremity surgical treatment of cervical spinal

cord injury with recommendations for the future

1
Jason Lin , Ida Fox 2
1
Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
2
Division of Plastic and Reconstructive Surgery, Washington University, St Louis, MO 63110, USA.
Correspondence to: Dr. Ida Fox, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine,
MSC-8238-43-1150, 660 South Euclid Avenue, Saint Louis, MO 63110, USA. E-mail: foxi@wustl.edu

How to cite this article: Lin J, Fox I. Review of outcomes measures used to evaluate upper extremity surgical treatment of
cervical spinal cord injury with recommendations for the future. Plast Aesthet Res 2024;11:8. https://dx.doi.org/10.20517/2347-
9264.2023.57
Received: 25 Jun 2023 First Decision: 28 Dec 2023 Revised: 21 Jan 2024 Accepted: 6 Feb 2024 Published: 21 Feb 2024

Academic Editor: Joseph M. Rosen Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Cervical spinal cord injury is a life-altering event that profoundly affects an individual’s upper extremity function.
Nerve transfer surgeries have been shown to restore more natural movement and fine motor control in this
population. At present, there is no consensus on how to evaluate the efficacy of these restorative surgeries. The
purpose of this work was to perform a comprehensive review of the existing literature and describe the outcome
measures used. We hypothesized that the assessments will be heterogeneous across studies and will incompletely
capture the effect of nerve transfers on upper extremity motion in cervical spinal cord injury. A search strategy was
designed and a review of multiple databases (Embase.com, Ovid-Medline All, and Scopus) yielded 481 articles; 26
unique studies met inclusion criteria and underwent analysis. Both manual muscle strength testing and video
content were presented in the majority of studies. Outcome assessments including myometry, functional outcomes
measures (such as the grasp and release test), patient-reported outcomes (including generic, extremity, and
disease-specific types), and custom de novo questionnaires were used variably across studies. Future work should
focus on standardizing outcomes measures in the field and developing and incorporating kinematic analysis to
quantify the intricate, coordinated, and precise movement attained after nerve transfer surgery in the setting of
cervical spinal cord injury.
Keywords: Nerve transfer surgery, upper extremity function, cervical spinal cord injury, tetraplegia, outcome
assessments, kinematic analysis

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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