University Hospitals Birmingham NHS Foundation Trust (UHB) has become the first trust in the country to carry out a new procedure aimed at restoring feeling and movement to the arms of tetraplegic patients.

The patient, father of three Leon Hill, sustained a cervical spine fracture resulting in paralysis of all four limbs in a road accident last year, and was referred to UHB following rehabilitation.

But consultant surgeons from the Birmingham Hand Centre at Queen Elizabeth Hospital Birmingham (QEHB) have "rewired" his right arm by transferring multiple nerves with the aim of restoring independent movement in his elbow, forearm, wrist and hand.

The procedure, known as nerve transfer surgery, was first carried out on a tetraplegic patient in the USA after he was left with upper and lower limb paralysis from a similar spinal cord injury.

He was able to gain independent finger function in his hands, enabling him to feed himself after 12 months, and surgeons at QEHB are hoping for similar success.

Dominic Power, Consultant Hand and Peripheral Nerve Surgeon at UHB, said: "We have been treating patients with complex peripheral nerve injuries using nerve transfer surgery for several years but the extension of this technique to patients with spinal cord injury and paralysis is a recent development.

“This is a very exciting area and it is wonderful for us to be able to offer this reconstruction to patients in the UK for the first time.

"I want Birmingham to become a national centre for the reconstruction of nerve injury and paralysis."

The Birmingham Hand Centre was established at UHB in 2003 and has now grown to include 11 consultant surgeons. It provides the complete spectrum of elective and trauma hand surgery, and is supported by a hand therapy service.

The expansion of the major trauma service at QEHB, as well as combat military injuries seen through the Royal Centre for Defence Medicine, has resulted in increasing numbers of complex reconstructive cases including peripheral nerve injuries.

This led to the establishment of a brachial plexus and peripheral nerve injury service in 2010, although this type of work was already being carried out from 2005.

The brachial plexus is a network of nerves from the spine to the arm supplying all upper limb movement and feeling. These nerves are injured by traction in falls and road traffic collisions and are also prone to injury with gunshot wounds and stabbings.

Nerve transfer surgery involves surgical rewiring of the human nervous system to bring live nerves close to the nerve ends of non-functioning muscles.

Mr Power said: "Rapid regrowth of the nerve into the dennervated muscle reliably restores function and can be used in a number of clinical scenarios where nerves are not working."

The nerve service at QEHB was resourced to provide assessment and management of four new cases a month, but the growth has been so dramatic that the hospital now receives around 40 referrals each month for assessment.

This includes upper limb nerve injury, lower limb nerve injury, nerve tumours, brachial plexus injuries, and paralysis from other causes such as degenerative spinal disc disease and spinal fractures.

Referrals are received not only from the West Midlands but from all over the UK and internationally, including the Middle East.

Mr Power said 42-year-old Mr Hill, who was in collision with a van while riding his bicycle to work in Herefordshire, underwent eight hours of surgery involving the transfer of six motor nerves, two sensory nerves and a tendon.

"There was one nerve root still working to his right shoulder and upper arm, so he was able to move his shoulder but nothing else," the surgeon added.

"So, we were able to transfer these eight nerve branches within his arm to effectively re-wire his limb. This was done by splitting the existing nerves and reconnecting them. We hope to give him the ability to reach with his arm and to grasp by restoring sensation and dexterity in his fingers.

"Surgery went well and the following day he was discharged to continue his rehabilitation.

"It is anticipated that he will begin to re-innervate the muscles in the next 2 – 4 months and then further improvements in strength and control will occur in the next 12 – 18 months."

There are approximately 1,200 new cases of traumatic spinal injury in the UK and Republic of Ireland each year that are sent for rehabilitation in the 12 designated spinal cord injury centres.

It is estimated from a 2008 study by the Spinal Injury Association that around half are cervical spine injuries and that, from these, between 120 and 150 patients in England and Wales would be suitable for assessment to potentially undergo this pioneering procedure.

Mr Power said: "Currently there is some provision for assessment by a hand surgeon at some of the spinal injury centres in the UK, but the published evidence suggests that upper limb functional gains are historically poor using splints and tendon transfers and there is a reluctance to refer patients for assessment by rehabilitation teams. Existing services are also not uniform.

"We hope that we are able to establish a national referral centre for this type of procedure at UHB and build on the experience gained so far.

"We have approached the British Society for Surgery of the Hand to undertake a review of UK upper limb services in tetraplegia and hope to further develop referral pathways with national spinal injury centres.

“Birmingham is well located, with 8 of the 12 national spinal injury centres within a two to three hour radius.

"In order for this technique to be offered, patients will need to be assessed earlier in the course of recovery from injury and we would recommend a specialist assessment by a nerve surgeon between 3 and 4 months from injury.

"This new approach will mean that referral pathways will need to be redesigned, and at UHB we are working with NICE and the spinal injury centres to effect these changes."

Case study – Leon Hill

Leon Hill was on his regular early morning cycle to work as a JCB and forklift truck driver in Ledbury, Herefordshire, when he suffered the injuries that would dramatically change his life.

It was around 6:30 on the morning of 7 November 2013 when Leon was in collision with a van travelling behind him, resulting in major injuries and the loss of movement in both his arms as well as both his legs.

He is now pinning his hopes of regaining some degree of independence on the surgeons at Queen Elizabeth Hospital Birmingham.

In the meantime, Leon waits in a private rehabilitation centre while a suitable adapted home can be found for him to return to his wife Amy, 35, and their children Harmani, 12, Sienna, 5, and Reagan, 4.

Amy said: “I was told that this procedure by Mr Power was new, so I was obviously a bit apprehensive. But compared to what Leon had before we had to try anything, to give him some independence for himself.

“He didn’t have any movement at all, so just to give him something, even if it means he can move his wheelchair, would be a big improvement. Anything would be better than what he had before.

“The nerve regrows at about a millimetre a day, so it will take time to reach his hand. It could be 6 – 12 months before he gets anything like full movement in his right arm.

“But the signs are already good. He started to feel some sensation down his arm within a few weeks and can now pull his arm right up to his mouth.

“The next step is to get his wrist and then his fingers moving, but Leon is quite positive. He’s doing OK.”

Amy said that Mr Power first visited Leon while in critical care at QEHB following the accident: “He said that if Leon hadn’t got any further movement in his arm would we be interested in seeing him, so we said we would. Then when Leon got moved to the Midlands Spinal Injuries Unit in Oswestry at the beginning of this year, I rang Mr Power to say we wanted to give it a try.”