Attending Physician Joshua M. Smith Providence, Rhode Island, United States
Case Diagnosis: Functional improvement in motor incomplete spinal cord injury (SCI) following tendon lengthening surgery 16 years post-injury.
Case Description: 64-year-old female with motor incomplete SCI secondary to spinal cord infarction in June 2008 had demonstrated full strength in the upper limbs, with trace movement in bilateral hip flexors and hip adductors, and no other motor function in the lower limbs. Sensation intact to the mid trunk, diminished to absent below. No voluntary movement at ankles with spasticity of bilateral plantarflexors managed with botulinum toxin injections. Despite therapeutic interventions, bracing, and toxin management, developed bilateral ankle plantarflexion contractures. In June 2023, underwent Achilles tendon lengthening and nerve transfer of left lower limb, followed by similar procedure to right in March 2024. Postoperatively, her ankles now achieve neutral positioning, and regained significant motor function, with 2/5 strength in ankle plantarflexion, dorsiflexion, and extensor hallucis longus bilaterally, alongside improving sensation in the lower limbs. She is currently ambulating short distances with bilateral AFOs and a walker, requiring contact guard assistance.
Discussions: Despite her injury occurring over a decade and a half ago, this patient achieved remarkable motor recovery, allowing her to ambulate at modified independent level using bilateral AFOs and walker with contact guard assistance. Motor recovery typically plateaus within 1-2 years post-SCI, yet this case exemplifies the potential for substantial functional improvement years after injury, facilitated by nerve transfer surgery and tendon lengthening in motor incomplete injury.
Conclusions: This case underscores the potential for nerve transfer surgeries to promote functional recovery in patients with motor incomplete SCI, even many years after the initial injury. The patient’s ability to ambulate with assistive devices 16 years post-injury highlights the promise of such interventions for long-term recovery.
