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Study Design: Retrospective audit., Objectives: The objective of this study was to identify the proportion of patients with cervical spinal cord injury who would potentially benefit from nerve transfer surgery to gain active hand opening, and to determine when a safe nerve transfer decision can be made., Setting: Christchurch, New Zealand., Methods: Case note review of the first 12 months following acute cervical spinal cord injury (2007-2012). Neurological assessment at 6 weeks, 12 weeks and 1 year following injury., Results: Fifty-three patients had complete assessments and showed changes in the level of injury and severity of neurological injury between assessments. Forty-two percent of patients had motor complete C5-7 level injuries 12 weeks following injury and would benefit from consideration for nerve transfer to improve hand opening. Fewer (26%) would benefit 1 year following injury owing to a change in the neurological level of injury., Conclusions: Twelve-week neurological assessment identifies patients who may benefit from nerve transfer surgery. This enables referral for comprehensive upper limb assessment and reassessment of motor function to determine suitability for surgical intervention. Nerve transfer within the window of opportunity provides active hand opening for patients following cervical spinal cord injury.

Study Design: Implementation study., Objectives: To describe the development and potential value of the New Zealand (NZ) upper limb surgery registry and report the demographic and spinal cord injury characteristics of individuals with tetraplegia collated to date., Setting: Multi Center-coordinated from Burwood Spinal Unit, NZ., Methods: Following discussions with eight international units, clinical information and outcomes measures were agreed upon for use in this specific population. To implement this consensus, a web-based upper limb surgery registry was developed in NZ. Inclusion criteria included referral to a hand clinic for clinical assessment for suitability for tendon transfer surgery. Clinical data were collected regardless of acceptance of surgery thereby creating a self-selected control group. Twenty-eight years of retrospective NZ data was entered into the registry, as well as 3 years of prospective data collected in NZ., Results: From 1982 to 2013, a total of 357 persons with tetraplegia were assessed as suitable for surgery. Of those, 223 individuals underwent surgery and 134 declined the intervention(s). The prospective group currently comprises 55 assessments with 23 surgery individuals and 32 who have declined surgery to date., Conclusion: Clinical information is now available within a web-based registry for all individuals reviewed in hand clinics from when upper limb surgery was first introduced. A broad range of outcomes of interest can easily be reported directly from the registry. The self-selected control group will allow comparative studies to be explicitly linked to the specific interventions of interest.

Study Design: Retrospective case series., Objective: To describe the uptake of upper limb surgery by individuals with tetraplegia in New Zealand (NZ)., Setting: New Zealand., Methods: The clinical notes of all individuals who sustained a cervical spinal cord injury between 1 January 2001 and 31 December 2005 were retrospectively reviewed for those who met the clinical criteria to undergo upper limb surgery. Cases were cross-referenced to the hand surgery record to determine the uptake of upper limb surgery in this cohort., Results: The uptake of upper limb surgery for people with tetraplegia in NZ was 44% of the eligible cohort and 59% of those assessed for surgery. This is notably higher than the reported proportion in other developed countries. The data also suggested that women and those who identified as NZ Maori were less likely to undergo upper limb surgery than were men and those of NZ European ethnicity., Conclusion: Utilization of upper limb surgery in the eligible tetraplegic population in NZ was high. However, it seemed that some groups were less likely to undergo surgery. Further research into the factors that affect an individual's decision to undergo upper limb surgery could explain the observed pattern.