Restoration of stepping-forward and ambulatory function in patients with paraplegia: rerouting of vascularized intercostal nerves to lumbar nerve roots using selected interfascicular anastomosis.

The objective of this study is to restore stepping-forward and ambulatory function in paraplegic patients with chronic injuries. Two to four normal vascularized intercostal nerves above the spinal cord injury site were obtained by cutting in the distal end at the midclavicular line. The proximal ends were disconnected from the levatores costarum. Nerves were then transferred to the vertebral canal through a submuscle tunnel and sutured with the selected fascicula of lumbar nerve roots (L 1/2 or L 3/4) by epiperineurial neurorrhaphy in the subdura or extradura. If the selected intercostal nerve was not of sufficient length to reach the specific lumbar region, a sural nerve segment was isolated, sheared into two segments, and attached to the intercostal nerve for grafting. Twenty-three patients, whose injury sites were between the thoracic T9 and T12 levels, were followed postoperatively for a period ranging from 2 to 11 (average: 3.5) years. Of these patients, 18 (78%) regained the stepping-forward function and were able to walk with crutches or other ambulatory assistive devices. In addition, 21 (91%) patients had improved thigh sensation. This intercostals nerve rerouting procedure restores significant stepping-forward and, in turn, ambulatory function and thigh muscle sensation in paraplegic patients.