C7 Neurotomy Enhances Language Recovery in Chronic Post-Stroke Aphasia

In a groundbreaking study published on June 25, 2025, in The BMJ, researchers from Fudan University in Shanghai have found that a surgical procedure known as right-sided cervical C7 neurotomy, when combined with intensive speech and language therapy (iSLT), significantly improves language recovery in patients suffering from chronic aphasia following a left hemisphere stroke. The randomized controlled trial involved 50 patients aged between 40 and 65 years, all of whom had experienced aphasia for more than one year post-stroke, a condition affecting more than 60% of stroke survivors beyond the first year, severely impairing their communication abilities and independence.

The study's lead author, Dr. Juntao Feng, MD, PhD, and his team observed statistically significant improvements in language function, quality of life, and even post-stroke depression among those undergoing the combined treatment as opposed to those receiving only iSLT. Specifically, the average increase in the Boston Naming Test (BNT) score was 11.16 points in the neurotomy plus iSLT group compared to just 2.72 points in the iSLT-only group, marking a significant 8.51-point difference (P < .001). This improvement in naming ability, which is typically resistant to therapy, was noted within just three days post-surgery, suggesting an immediate neuromodulatory effect of the neurotomy itself.

Chronic aphasia presents a considerable challenge as it diminishes the quality of life and social interactions for many stroke survivors. While iSLT remains the standard intervention, its efficacy is often limited, prompting a search for adjunct treatments that can yield sustained benefits. The findings from this trial could represent a pivotal shift in treatment paradigms for chronic aphasia, potentially establishing C7 neurotomy as a viable adjunctive option, especially for younger patients who have not seen improvement from conventional therapies.

Dr. Larry B. Goldstein, MD, chair of the Department of Neurology at the University of Kentucky, remarked on the study’s intriguing results, calling them ‘interesting and provocative.’ However, he pointed out several limitations, including the predominance of male participants (80%) and the relatively young age of the cohort, which is atypical for stroke patients. He emphasized the need for further research in more diverse populations to validate these findings.

Dr. Supattana Chatromyen, MD, from the Neurological Institute of Thailand, echoed these sentiments, suggesting that while intensive SLT remains the cornerstone of aphasia treatment, the integration of C7 neurotomy could encourage a reevaluation of rehabilitation strategies and policies in chronic stroke care. The researchers plan to extend their follow-up with participants to five years to assess long-term outcomes and explore the applicability of their findings in a broader, international context.

Despite the promising results, some complications were reported, including transient neuropathic pain and minor motor function deficits in the right upper limb, which resolved within two months. Importantly, no severe adverse events were linked to the procedure, further supporting the potential for C7 neurotomy to be considered an evidence-based intervention for chronic post-stroke aphasia.

As the field of stroke rehabilitation evolves, this study may catalyze further scientific inquiry into surgical interventions, fostering a more optimistic outlook on recovery for those grappling with the long-term effects of stroke-induced aphasia. Future research will be essential in determining the broader applicability of these findings and in refining treatment protocols to enhance the quality of life for stroke survivors worldwide.