Clinical data were collected from patients diagnosed with spastic hemiplegia and treated in our hospital's neurosurgery department between 2022 and 2023. Inclusion Criteria: ① Patients with hemiplegia resulting from cerebral palsy, traumatic brain injury, ischemic stroke, hemorrhagic stroke, or exhibiting stiffness and weakness in the contralateral upper limb due to brain injury; ② Patients undergoing regular rehabilitation treatment with no significant improvement in limb function on the affected side post-treatment; ③ Surgical patients required to undergo regular rehabilitation for six months following surgery; Non-surgical patients must have received regular rehabilitation treatment for at least one year. Experimental Groups: Experimental group (Cervical 7 Nerve Surgery group); Control group (Physical Rehabilitation group). Evaluation Metrics include: The Modified Ashworth Scale (MAS) is used to assess spasticity levels in the elbow, forearm, wrist, thumb, and fingers, with higher scores indicating more severe muscle tone (6 levels: 0, 1, 1+, 2, 3, 4, scored 0, 1, 2, 3, 4, 5, respectively, with higher scores indicating higher muscle tone and more severe spasticity); The Simplified Fugl-Meyer Assessment (FMA) is used to evaluate upper limb motor function, with a maximum score of 66, higher scores indicating better limb function. Assess the patient's physical balance function using the Berg Balance Scale (BBS) (14 items, each with 5 functional levels, scored 0, 1, 2, 3, and 4 points, respectively, with higher scores indicating better balance function); Evaluate the severity of aphasia in patients using the Boston Diagnostic Aphasia Examination (BDAE) grading system, which ranges from 0 to 5, with 0 indicating no meaningful speech or auditory comprehension and 5 indicating minimal distinguishable speech impairment. Patients undergoing neck 7 displacement surgery were followed up at 6 and 12 months postoperatively, while the control group was also followed up at 6 and 12 months after a year of regular rehabilitation treatment. Statistical Analysis: Data were analyzed using SPSS 25.0 statistical software. Fugl–Meyer scores, BDAE scores, and BBS scores were subjected to repeated measures analysis of variance, and independent sample t-tests were used for comparisons between the two groups at the same time point. Bonferroni correction was applied for pairwise comparisons between the same group at different time points. The MAS scores were assessed using the Mann-Whitney test. A P-value of less than 0.05 was considered statistically significant. All methods were in accordance with the relevant guidelines and regulations of Suining Central Hospital
Surgical Procedures: All surgical procedures in our hospital utilize the anterior cervical approach, with each of the 14 surgeries performed by the same chief physician. Our surgical approach is primarily based on the Huashan Hospital's anterior cervical approach protocol [9]. Prior to surgery, clearly mark the healthy side with "YES" and the affected side with "NO". Following general anesthesia, neuroelectrophysiological monitoring is conducted to aid surgeons in rapidly locating the target nerve during the procedure. The surgery begins with sequential layered incisions on the healthy side, progressing from the skin, subcutaneous layer, cervical membrane, to the latissimus muscle, gradually revealing the transverse carotid arteries and veins (ligature possible). Initially, the sternocleidomastoid muscle is pulled towards the midline, revealing the anterior scalene muscle beneath the transverse jugular artery and vein. This muscle's inner margin harbors a phrenic nerve that must be carefully preserved (exposure only, no full dissection). The outer margin of the anterior scalene muscle is gently separated to expose the upper trunk, which is superficial and composed of C5 and C6 converging into it, further dividing into three strands, allowing for partial dissection to prevent injury or traction. The middle trunk is then located deep in the midline, with C7 acting as an independent trunk. A small long thoracic nerve is identified and separated beneath the clavicle for subsequent transection. C7 extends diagonally downwards and outwards towards the clavicle, diverging into two strands. It is crucial not to damage the femoral confluence with C7 after the lower trunk, and both strands should be cut as distally as possible. It is important to note that nerves extending out from C7 may be severed, but those running towards C7 should be left intact. The lower trunk is a shorter and thicker section located inferior to the middle trunk, differentiated by its electrophysiological properties from the upper and middle trunks. (Stimulating the middle trunk primarily activates the radial nerve, resulting in elbow flexion.) The C7 nerve root is dissected towards the intervertebral foramen, with care taken to protect the phrenic nerve, vertebral artery, and surrounding venous plexus. On the inner edge of the phrenic nerve, a portion of the anterior scalene muscle is resected, progressing from superficial to deep levels, until reaching the intervertebral foramen. Carefully palpate the vertebral artery and the intervertebral foramen, utilizing the space behind the vertebral artery to converge towards the outer edge of the long neck muscle. Initially, C7 is repositioned from beneath the anterior scalene muscle, which lies beneath the phrenic nerve, to the intervertebral foramen. Subsequently, the sternocleidomastoid muscle is pulled laterally, ensuring complete dissection from the blunt fingers in the anterior neck to the anterior edge of the long neck muscle. Great care is taken to protect the vertebral artery, venous plexus, phrenic nerve, esophagus, and internal carotid artery, avoiding excessive traction. The procedure involves threading the nerve roots with right-angle forceps or large hemostatic forceps, using five-colored tape for gentle traction, avoiding excessive pressure, and clamping the nerve sheath rather than the nerve fibers. The method for exposing C7 on the affected side is similar, with the emphasis on identifying C7 and disconnecting it at the intervertebral foramen. The critical aspect is to identify the shortest pathway, which runs laterally to the long neck muscle behind the vertebral artery. Ultimately, the healthy nerve root is guided through the anterior esophagus, passing between the long neck muscle and the healthy side, facilitating end-to-end anastomosis. The nerve fibers, once neatly trimmed, are sutured into bundles individually. The nerve sheaths are carefully aligned and tightly sutured, and nerve tubes are employed to prevent adhesion (refer to Fig. 1).