Right C7 Neurotomy Enhances Language Recovery in Post-Stroke Aphasia: Study
Researchers have found in a new study that among patients with chronic aphasia following stroke, combining right seventh cervical nerve (C7) neurotomy with intensive speech and language therapy (SLT) led to greater improvements in language function compared to speech and language therapy alone. The study was published in BMJ by Juntao Feng and colleagues.
Aphasia, one of the frequent long-term sequelae of left hemispheric stroke, frequently entraps patients with difficulty in communication years after the insult. The research recruited 50 adults between the ages of 40 and 65 years with greater than a year of aphasia after a single stroke. The results present a new promise for patients who in the past had suboptimal recovery following standard therapy.
The trial was implemented in four centers in mainland China from July 2022 to July 2023. A total of 1,086 post-stroke aphasia patients were screened, and 322 of them were diagnosed with persistent aphasia. Fifty available subjects were randomly assigned in equal numbers to two groups: one received right C7 neurotomy at the intervertebral foramen and subsequent three weeks of intensive SLT, and the control group received merely three weeks of intensive SLT after deferral for one week. Allocation was stratified by treatment centres to account for potential differences between treatment centers. All outcomes were measured by blinded examiners.
The main outcome measure was improvement in scores on the 60-item Boston Naming Test (BNT), which assesses naming capacity (score range 0–60). At one month, the neurotomy plus SLT group improved by a mean of 11.16 points compared with 2.72 points in the control group—a significant difference of 8.51 points (95% CI: 5.31 to 11.71; P<0.001). This benefit was maintained at six months with a group difference of 8.26 points (95% CI: 4.16 to 12.35; P<0.001).
Secondary results were the aphasia quotient on the Western Aphasia Battery. The group that received neurotomy had a mean improvement of 7.06 over the control group at one month (95% CI: 4.41 to 9.72; P<0.001). Participants also showed increased quality of life, better activities of daily living, and less depression symptomatology. Importantly, no serious treatment-related adverse events or long-term adverse effects were reported.
Key Findings
Participants: 50 (25 per group), 40–65 years with aphasia >1 year
Primary Outcome (BNT score at 1 month):
Neurotomy + SLT: +11.16 points
SLT only: +2.72 points
Difference: +8.51 points (95% CI: 5.31 to 11.71; P<0.001)
BNT Score at 6 months:
Sustained improvement with +8.26 point difference (95% CI: 4.16 to 12.35; P<0.001)
Aphasia Quotient (1 month):
Difference: +7.06 points (95% CI: 4.41 to 9.72; P<0.001)
Other Improvements:
Improved daily functioning
Decreased post-stroke depression
Safety
No severe side effects or lasting side effects noted
Right C7 neurotomy with intensive speech and language therapy was significantly more effective for enhancing language function in patients with chronic post-stroke aphasia than SLT alone. The effects lasted for six months without significant side effects, suggesting this combination therapy as a potentially useful method for the management of chronic aphasia.
Reference:
Feng, J., Hu, R., Lyu, M., Ma, X., Li, T., Meng, Y., Qi, W., Li, H., Zhang, Y., Ding, S., Wang, Z., Chen, X., Zheng, J., Fan, Y., Ding, L., Wang, L., Wei, Z., Zhu, X., Guo, M., … Xu, W. (2025). Right C7 neurotomy at the intervertebral foramen plus intensive speech and language therapy versus intensive speech and language therapy alone for chronic post-stroke aphasia: multicentre, randomised controlled trial. BMJ (Clinical Research Ed.), 389, e083605. https://doi.org/10.1136/bmj-2024-083605
