Background: In patients with cervical spinal cord injury (SCI), time to upper extremity reconstructive surgery is important because nerve reconstructive procedures must be done early in the case of lower motor neuron injury, while tendon procedures may be delayed. We evaluated timing and utilization of nerve and tendon reconstructive procedures in patients with cervical SCI. Methods: TriNetX was queried to identify patients with cervical SCI undergoing nerve transfer, selective neurectomy, tendon lengthening, tenodesis, and tenolysis, using ICD-10 & CPT codes. Groups were stratified based on timing of intervention (within or after 1 year of SCI). Baseline characteristics, including age, sex, and race were collected, and controlled for using propensity score matching. Results: Among 71,981 patients with cervical SCI, 581 (0.8%) underwent any upper extremity reconstructive procedure. Significantly more patients received tendon procedures (68.2%) compared to nerve procedures (25.3%) (p < 0.05), with 38 patients receiving both (6.5%). This pattern persisted both within and after 1 year of cervical SCI, with tendon procedures being more prevalent than nerve procedures (< 1 year: 71.0% vs. 29.0%; >1 year: 68.3% vs. 31.7%; p < 0.0001). Patients receiving nerve procedures were younger (47.6±17 versus 54.2±18 years, p<0.001) and in both cohorts, male patients comprised a higher proportion than female patients (nerve-related: 73.0 % versus 26.0%, tendon-related: 62.0% versus. 36.0%,) and White patients comprised a higher proportion than patients belonging to any other race (nerve-related: 67.0 % versus 33.0 %, tendon-related: 67.0% versus. 33.0%,). However, upon matching, no statistically significant differences were found in the odds of receiving either procedures based on sex, race, or ethnicity. Conclusions: Higher percentage of patients received tendon procedures compared to nerve procedures, including those who had surgery within 1 year of SCI, suggesting an opportunity for increased utilization of nerve transfers in eligible patients presenting within 1 year of SCI.
