Return of spinal reflex after spinal cord surgery for brachial plexus avulsion injury

Department of Hand Surgery, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden.
Journal of Neurosurgery (Impact Factor: 3.74). 08/2011; 116(2):414-7. DOI: 10.3171/2011.7.JNS111106
Source: PubMed

ABSTRACT Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch.

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Available from: Thomas Carlstedt, Sep 27, 2015
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    • "Although the continuous pain is the more immediate problem, lesions in sensory pathways trigger significant changes in motor control (Scott, 2012), since the intraspinal circuits are directly affected, disturbing the motor coordination (Carlstedt and Havton, 2012; Carlstedt et al., 2012). Taking that into account, it is relevant to study lesions to dorsal roots alone and develop strategies that may allow the restoration of the motor-sensory integration. "
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    ABSTRACT: Root lesions may affect both dorsal and ventral roots. However, due to the possibility of generating further inflammation and neuropathic pain, surgical procedures do not prioritize the repair of the afferent component. The loss of such sensorial input directly disturbs the spinal circuits thus affecting the functionality of the injuried limb. The present study evaluated the motor and sensory improvement following dorsal root reimplantation with fibrin sealant (FS) plus bone marrow mononuclear cells (MC) after dorsal rhizotomy. MC were used to enhance the repair process. We also analyzed changes in the glial response and synaptic circuits within the spinal cord. Female Lewis rats (6–8 weeks old) were divided in three groups: rhizotomy (RZ group), rhizotomy repaired with FS (RZ+FS group) and rhizotomy repaired with FS and MC (RZ+FS+MC group). The behavioral tests electronic von-Frey and Walking track test were carried out. For immunohistochemistry we used markers to detect different synapse profiles as well as glial reaction. The behavioral results showed a significant decrease in sensory and motor function after lesion. The reimplantation decreased glial reaction and improved synaptic plasticity of afferent inputs. Cell therapy further enhanced the rewiring process. In addition, both reimplanted groups presented twice as much motor control compared to the non-treated group. In conclusion, the reimplantation with FS and MC is efficient and may be considered an approach to improve sensory-motor recovery following dorsal rhizotomy.
    Frontiers in Neuroanatomy 09/2014; 8. DOI:10.3389/fnana.2014.00096 · 3.54 Impact Factor
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    ABSTRACT: To study the effective recovery of the quadriceps femoris by spinal ventral root cross-anastomosis in rats. End-to-end anastomosis was performed between the left L(1) and L(3) ventral roots using autogenous nerve graft, and the right L(1) and L(3) roots were left intact. In control animals, the left L(3) ventral root was cut and shortened, and anastomosis was not performed. Six months postoperatively, the movement of low extremities was detected by electrophysiological examination, hindlimb locomotion and basso, beattie and bresnahan (BBB) scoring at one, three, seven, 14, 21 and 28 days after SCI. Fluorescence retrograde tracing with TRUE BLUE (TB) and HE staining were performed to observe the nerve regeneration. Six months after surgery, the anastomotic nerve was smooth and not atrophic. The amplitudes of action potential were 7.63 ± 1.86 mV and 6.0 ± 1.92 mV respectively before and after the spinal cord hemisection. The contraction of left quadriceps femoris was induced by a single stimulation of the anastomotic nerve. The locomotion of left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. In addition, there was significant difference in the BBB score at one, three and seven days after SCI. TB retrograde tracing and neurophysiologic observation indicated efficient reinnervation of the quadriceps femoris. The cross-anastomosis between spinal ventral root can partially reconstruct the function of quadriceps femoris following SCI and may have clinical implication for the treatment of human SCI.
    Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 05/2012; 27(5):330-7. DOI:10.1590/S0102-86502012000500009 · 0.66 Impact Factor
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    ABSTRACT: The fundamental cellular processes which underlie regeneration are similar in the laboratory, in the injuries of civilian practice and in the wounds of war, but they are modified by the violence of the injury, by the effects of injury on associated tissues and in particular by ischaemia and by delay before repair. It is important to remember the differences between the laboratory investigation, in which a controlled, precise and limited lesion is inflicted upon a nerve and the situation faced by the clinician presented with a patient with a massive wound involving the soft tissues, the skeleton, the vessels and sometimes by other injuries which threaten life and limb. The demonstration of regenerating axons across a lesion of a nerve inflicted in the laboratory does not necessarily translate to the recovery of function in the human. The phenomena of pain and recovery of sensation are rather poorly revealed by experiments upon small mammals or for that matter by barely justifiable experimentation upon primates.
    Peripheral Nerve Injuries: A Clinical Guide, 01/2013: pages 113-141; , ISBN: 978-1-4471-4612-4