Nerve Transfer After Spinal Cord Injury- Multi-center

Inclusion Criteria 1. Age 18-65, inclusive 2. At least 3 months of non-operative rehab therapy 3. Mentally and physically willing and able to comply with evaluations 4. Less than 36 months post-injury 5. Stable ASIA scores with no evidence of functional improvement in motor or sensory examination for at least 3 months 6. ASIA A or B determined by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) 7. EMG/NCS verifies intact innervation (normal CMAPs) to the paralyzed target muscles below the level of injury 8. Functional electrical stimulation (FES) will be performed. Subject must have clinically normal MRC grade 5/5 donor (axonal) function 9. Injury Level C4-C8 Exclusion Criteria 1. Active infection at the operative site or systemic infection 2. Any return or ongoing clinical recovery of distal motor function 3. Mentally or physically compromised that will prevent them from complying with evaluations. 4. Immunologically suppressed 5. Currently undergoing long-term steroid therapy 6. Active malignancy 7. Pregnant 8. Significant joint contractures and/or limitations in passive range of motion in the arm or hand, per treating surgeon's discretion 9. Lack of appropriate social support and/or infrastructure to commit to scheduled follow-up visits. 10. Patients who are planning on undergoing a tendon transfer during the study period or who have had a tendon transfer in the past.