Posterior versus anterior approach for contralateral C7 nerve transfer in post-stroke upper limb spastic hemiplegia: A comparative retrospective study

Several surgical approaches for contralateral C7 (CC7) nerve root transfer (NRT) exist, but they come with challenges such as long nerve bridging distances, complex surgical anatomy, and prolonged recovery times. Our objective was to evaluate and compare the clinical efficacy and safety of the posterior single-incision CC7 (PSCC7) NRT approach (posterior group) with the traditional anterior CC7 (ACC7) NRT approach (anterior group) for treating post-stroke upper limb spastic hemiplegia (PULSH). In this retrospective study, we retrieved and compared clinical efficacy as well as safety of the posterior group with the traditional anterior group for treating PULSH between February 2024 and February 2025. Key outcome measures included operative time, intraoperative blood loss, postoperative complications, and functional recovery at 6-month follow-up. In all, 12 patients who underwent the posterior group and 30 patients (control group) who underwent the traditional anterior group were retrieved from the hospital records. The posterior group demonstrated significantly shorter operative times (3.2 ± 0.5 hours vs 4.5 ± 0.8 hours, P < .01) and less intraoperative blood loss (150 ± 4 0 mL vs 280 ± 70 mL, P < .01) compared to the anterior group. The posterior group achieved comparable or superior improvements in Modified Ashworth Scale scores (1.2 ± 0.3 vs 1.5 ± 0.4, P > .05) and Berg Balance Scale scores (42 ± 5 vs 39 ± 6, P > .05). The posterior group is a safe and effective treatment for PULSH. It offers the advantages of reduced surgical trauma and shorter operative time.