Nerve Transfer After Spinal Cord Injuries

Inclusion Criteria: 1. 18-65 years of age 2. Informed Consent Document (ICD) signed by patient 3. Cervical spinal cord injury resulting in arm \& hand functional impairment, with at least preserved elbow function 4. International Classification of Surgery of the Hand in Tetraplegia (ICSHT) category 0 - 4 5. Patients with a stable American Spinal Injury Association (ASIA) grade of A, B, or C, or with a diagnosis of central cord syndrome, showing minimal to no evidence of functional improvement in motor examination after at least 6 months of non-operative therapy post-injury 6. Appropriate candidate for nerve transfer study 7. Willing and able to comply with the study protocol 8. \< 48 months from injury Exclusion Criteria: 1. Active infection at the operative site or systemic infection 2. Any return or ongoing clinical recovery of distal motor function within 6 months after injury 3. Physically or mentally compromised 4. Currently undergoing long-term steroid therapy 5. Significant joint contractures and/or limitations in passive range of motion in the arm or hand 6. Active malignancy 7. Systemic disease that would affect the patient's welfare or the research study 8. Pregnant 9. Immunologically suppressed or immunocompromised 10. Significant pain or hypersensitivity 11. Previous or current injury preventing use of tendon transfers to restore upper extremity function 12. Affective disorder of a degree that would make outcome assessment and study participation difficult 13. History of brachial plexus injury or systemic neuropathic process