Repair of avulsed ventral nerve roots by direct ventral intraspinal implantation after brachial plexus injury
Section snippets
Prior research
In the 1980s, several researchers working with animal models showed that implantation of a peripheral nerve graft into the spinal cord can induce regeneration of spinal motor neurons, which grow a matter of centimeters across the graft [6], [7], [8], [9], [10], [11]. From such results, extensive work was performed to investigate the efficacy of implanting peripheral nerve grafts in the cervical cord. This work shed much light on the subject. Six weeks after nerve root avulsion, the death of
Aims
The current authors hoped to show that reimplantation can work in humans if it is performed correctly, and that it can restore function, even in patients with avulsion of multiple nerve roots controlling several different groups of muscles. The authors also wanted to show that this technique, which restores communication from the spinal cord to the periphery, can diminish or abolish deafferentation pain.
Anatomic basis of the posterior approach to the brachial plexus for repairing avulsed spinal nerve roots
The authors' first step was to understand the work of Carlstedt to account for its relative
Reimplantation surgery of the brachial plexus: the place of neurotrophic factors
With this surgical method, several questions remain unanswered and certain limitations have become clear, notably the fact that a long interval between the injury and the operation is bound to curtail the degree of recovery possible.
It was long believed that differentiated neurons could not regenerate in the adult CNS. As previously discussed, physicians now know that this capacity exists, although in the real world its power is limited.
The problem of glial healing and inhibitory substances in
Summary
Currently, the authors' research confirms that, in humans, communication between the cord and effector muscles can be re-established after multiple nerve root avulsion by the implantation of peripheral nerve grafts. Outcomes are still modest, but the possibility of improvement exists. The technique of reimplantation makes it possible to envisage global repair with the possibility of repair of all avulsed regions. The most important factor that could maximize the extent of functional recovery is
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Diagnosis and management of adult BPI: Results of first 50 cases
2021, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Various secondary procedures include arthrodesis for shoulder joint, flail wrist, or thumb and fingers in functional position, tendon transfer, and functional free muscle transfer.20–24 BPI remains an active area for research; which includes re-implanting or connecting nerves back into the spinal cord with nerve grafts.25–29 However, few clinical studies have shown promise and procedures at this stage remain experimental.
DuraSeal as a Ligature in the Anastomosis of Rat Sciatic Nerve Gap Injury
2010, Journal of Surgical ResearchCitation Excerpt :Root avulsion usually occurs in brachial plexus injury. However, the repair of root avulsion with suture is very difficult due to narrow surgical fields and the presence of surgical tension between anastomotic ends [8]. To simulate surgical tension in surgical repair, the nerve gap model was constructed by excising the sciatic nerve (5 mm in length), leaving a 5 mm nerve tissue defect between the nerve stumps.
The anatomy, investigations and management of adult brachial plexus injuries
2009, Orthopaedics and TraumaCitation Excerpt :Repair of avulsed spinal nerve roots has been attempted by many, with Bonney and Jamieson reporting on a case in 1979. Both Jamieson and Carlstedt have published experimental work on animal models with some functional success28,29 and early work has emerged on human subjects.30,31 Despite this, to date, this surgical option has not reached the stage where it warrants inclusion in the standard surgical armamentarium.
Brachial plexus reconstruction based on the new definition of level of injury
2008, InjuryCitation Excerpt :The purpose of this article is to provide strategies for reconstruction of traumatic brachial plexus injuries in the adult, based on the different levels of the injury. Various classifications of the level of brachial plexus injury (BPI) have been proposed 2–4,6–14,17 (Table 1). A more recent classification reported by Chuang 5 has more precisely defined the level of lesions.
Functional reconstruction following brachial plexus avulsion
2007, Neural Regeneration Research