At her home in Lachute, Que., Jeanne Carrière pulls her wheelchair as much as the kitchen counter and cuts an apple into slices. For Carrière, it is a big deal — she’s using her hands in a way she never thought she would again.
Carrière, who’s quadriplegic, had been unable to make use of her hands or lower body after breaking her neck in 2021. While she had been capable of regain some movement in her arms, that wasn’t the case for her hands.
But in July 2022, she underwent surgery at Montreal’s Maisonneuve-Rosemont Hospital that has given her back a few of what she lost.
The 27-year-old screenwriter now lives in a ground-floor apartment below her parents’ home that is adapted to her physical needs.
Carrière said the primary time she saw her fingers move on their very own after the surgery was like watching “a baby with their first step.”
“It was step one into my latest life.”
9 hours within the operating room
Two surgeons and two teams of medical staff worked for nine hours, each focused on a distinct arm. It was captured on camera by Radio-Canada’s science program, Découverte.
The goal of the surgery, generally known as a nerve transfer, was to attach a few of Carrière’s nerves that also worked to those who were now not communicating together with her brain attributable to her damaged spinal cord.
“Principally we’re rerouting the nerves and bringing latest electrical input to those denervated muscles,” said Dr. Elie Boghossian, one in every of the surgeons who operated on Carrière.
The doctors opened Carrière’s arms and situated nerves still communicating with the brain that begin above the injury to her spinal cord. Under a microscope, they connected them to the non-functioning nerves further down, below the injury, using sutures finer than human hair.
The rehabilitation process following surgery helps teach the brain to follow the brand new nerve paths as a substitute of the old ones. Constructing that plasticity takes time.
“With time, the patient gets function back and mobility, eventually,” Boghossian said.
While that function could also be limited to small hand movements resembling pinching and grasping, for Carrière and other patients, it’s crucial since it gives them back some independence.
“Now it’s unbelievable what my hands can do,” Carrière said. “I can brush my teeth, I can cook.”
Surgery offers patients hope
Nerve transfer surgeries have been performed for several years and have gotten increasingly popular — but mainly for smaller injuries in hands or feet, said Dr. Ming Chan, a clinician-scientist on the University of Alberta in Edmonton.
Applying the technique to patients with spinal cord injuries is a more recent practice, showing a whole lot of promise, but there are limited results to review thus far, Chan said.
“In the intervening time, it really is just too early to say with certainty that it will work on every patient that we operate on,” he said.
Still, Chan said, for some patients with spinal cord injuries, this kind of surgery can provide “some hope and likewise a probability to get well a few of those functions.”
That sense of hope motivates Dr. Dominique Tremblay, the opposite plastic surgeon at Maisonneuve-Rosemont Hospital who operated on Carrière.
Tremblay said the 14 nerve transfer surgeries on spinal cord patients that she and Boghossian have done thus far will bring lasting advantages to the patients, and he or she would really like to see the practice proceed to evolve within the years ahead.
“It is kind of a little bit of work, but we’re completely determined and convinced that it is a life-changing surgery,” Tremblay said.
Chan said as more surgeries are done, experts in the sphere can share best practices around what works and what doesn’t with the intention to improve practices.
Seeking to the long run
After the surgery, the followup and rehabilitation take about two years, Tremblay said.
The nerve fibres must grow into the affected muscle, and that could be a slow process.
Carrière does day by day exercises together with her hands — easy movements like making a fist, and pinching her thumb and forefinger together — and goes to rehabilitation therapy twice a month to work with specialists.
She said one of the crucial necessary changes in recent months is that she has been capable of return to work — she’s writing a screenplay and might type on her computer.
Carrière said she’s anticipating further changes within the months to come back, as her body gets used to the brand new nerve pathways created by the surgery.
“It’s only the start,” she said. “It is very exciting.”