1.1 The evidence on efficacy of nerve transfer to partially restore upper limb function in tetraplegia is limited in quantity. There are no major safety concerns. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
1.2 Clinicians wishing to do nerve transfer to partially restore upper limb function in tetraplegia should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having nerve transfer to partially restore upper limb function in tetraplegia. NICE has identified relevant audit criteria and has developed an audit tool.
1.3 Patient selection and treatment should be done by a multidisciplinary team with expertise in managing spinal cord injury, and nerve and tendon transfers. This team should typically include a surgeon with experience in the surgical management of tetraplegia and nerve transfer, an occupational therapist, a physiotherapist with experience in spinal injury rehabilitation, a spinal injuries consultant and a neurophysiologist.
1.4 NICE may update the guidance on publication of further evidence.