scholarly journals Calcaneal Osteotomy Safe-Zone to Prevent Neurological Damage

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Parke Hudson ◽  
Cesar de Cesar Netto ◽  
Bahman Sahranavard ◽  
Brent Cone ◽  
Ibukunoluwa Araoye ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Average Distance ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Neurological Deficits ◽  
Nerve Injuries ◽  
Common Procedure ◽  
Calcaneal Osteotomy

Category: Ankle, Hindfoot Introduction/Purpose: Calcaneal osteotomy is a relatively common procedure used to address hindfoot deformities with a lateral calcaneal slide being utilized in the treatment of varus deformities and a medial slide for valgus deformities. This procedure does put neurological structures at risk. Specifically, a lateral approach jeopardizes the sural and lateral calcaneal nerves, while a medial approach endangers the medial plantar, lateral plantar, and calcaneal nerves. A previous cadaveric study described a neurological “safe zone” 11.2 mm anteriorly from “line A” which was described as extending from the posterior-superior aspect of the calcaneal tuberosity to the origin of the plantar fascia. We performed a retrospective chart review to correlate the positioning of the calcaneal osteotomy and the presence of neurological injuries. Methods: In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution in the past 5 years (January 1, 2011 to December 31, 2015). All immediate postoperative radiographs were examined and the distance between the calcaneal osteotomy line and line A was measured. If this distance was less than 11.2 mm the osteotomy was defined as “inside the safe zone”, over 11.2 mm was defined as “anterior to safe zone”, and osteotomies posterior to line A were defined as “posterior to the safe zone”. We correlated the positioning of the osteotomy with the presence of postoperative neurological findings, including damage to the sural, calcaneal, or plantar nerves, presenting as paresthesias or numbness in the nerves’ distributions. Results: Overall, we identified 179 calcaneal osteotomy cases with adequate radiographs and follow-up for inclusion in our analysis. Seven patients experienced postoperative neurological deficits consistent with iatrogenic nerve injury. Of these patients, 28.6% (2/7) had osteotomies anterior to the safe zone with an average distance of 18.40 mm anterior to line A. The remaining 5 (71.4%) received osteotomies inside the safe zone, an average of 7.12 mm anterior to line A. Of the patients who did not sustain nerve injuries 36.0% (62/172) had osteotomies anterior to the safe zone with an average distance of 15.40 mm anterior to line A, 66.2% (107/172) were inside the safe zone with an average distance of 7.84 mm, and 1.7% (3/172) were posterior to the safe zone. Conclusion: Our findings suggest a clinical safe zone in calcaneal osteotomies may not actually exist. Although not statistically significant due to the low prevalence of nerve injury overall, a greater percent (71.4%) of patients with nerve injuries had their osteotomies performed within the safe zone when compared to neurologically intact postoperative patients (66.2%). This data may indicate the lack of a true safe zone, likely due to wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed risk of nerve injury before undergoing calcaneal osteotomy.

Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?

2018 ◽  
Vol 12 (1) ◽  
pp. 34-38
Author(s):  
Bradley Wills ◽  
Sung Ro Lee ◽  
Parke William Hudson ◽  
Bahman SahraNavard ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Neurological Complications ◽  
Safe Zone ◽  
Reference Line ◽  
Calcaneal Osteotomy ◽  
Significant Difference ◽  
Osteotomy Line

Background. Calcaneal osteotomy is a commonly used surgical option for the correction of hindfoot malalignment. A previous cadaveric study described a neurological “safe zone” for calcaneal osteotomy. We performed a retrospective chart review to evaluate the presence of neurological injuries following calcaneal osteotomies and the location of the osteotomy in relation to the reported safe zone. Methods. In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution from 2011 to 2015. All immediate postoperative radiographs were examined and the shortest distance between the calcaneal osteotomy line and a reference line connecting the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia was measured. If the osteotomy line was positioned within an area 11.2 mm anterior to the reference line, it was considered to be inside the neurological safe zone. We correlated the positioning of the osteotomy with the presence of postoperative neurological complications. Results. We identified 179 calcaneal osteotomy cases. Of the 174 (97.2%) nerve injury-free cases, 62.6% (109/174) were performed inside the defined “safe zone” while 37.4% (65/174) outside. A total of 5 (2.8%) nerve complications were identified: 3 (60%) were inside the safe zone and 2 (40%) outside the safe zone. Osteotomies outside the safe zone had a 1.114 relative risk of nerve injury with a 95% CI of 0.191 to 6.500 and showed no statistically significant difference ( P = .9042). Conclusion. Our findings suggest that the clinical “safe zone” in calcaneal osteotomies may not actually exist, likely because of wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed, risk of nerve injury before undergoing calcaneal osteotomy. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals Does nerve injury following minimally invasive calcaneal osteotomy clinically correlate to Talusan’s Zone?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0048
Author(s):  
Kar Teoh ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Safe Zone ◽  
Lateral Side ◽  
Surgical Morbidity ◽  
Closing Wedge ◽  
Calcaneal Osteotomy ◽  
Alternative Method ◽  
Calcaneal Tuberosity

Category: Hindfoot Introduction/Purpose: Talusan et al (FAI, 2005) described a safe zone for neural structures in medial displacement calcaneal osteotomy following a cadaveric and radiographic investigation. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line which is from the plantar fascia origin through the center of the posterosuperior aspect of the calcaneal tuberosity. Minimally invasive calcaneal osteotomies been gaining in popularity as it minimises soft tissue disruption and surgical morbidity. However, neural structures are at risk on both the medial and lateral side of the foot during this procedure. We aim to correlate our clinical results with Talusan’s Radiographic Zone (TRZ) following minimally invasive calcaneal osteotomies. Methods: Sixty-three calcaneal osteotomies were performed in our unit from 2010 and 2016. The type of osteotomies was as follows: Medialising, n = 34; Lateralising n =15; Zadek (Dorsal closing wedge), n =13; and Dwyer (lateral closing wedge), n = 1. Clinical data were recorded with any nerve injury noted. The calcaneal osteotomies were graded into whether they fell into TRZ. We also evaluated Talusan’s alternative method which he described and is based on alternative line 60% of the distance from the angle of Gissane to the tip of most posterior aspect of the calcaneal tuberosity where the safe zone is a window 5.6 mm anterior to this. Results: Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported sural nerve paraesthesia following surgery in our series. However, this was transient and they recovered fully. In total, seven patients (Medialising, n = 4; Lateralising n =1; Zadek, n =1; Dwyer, n=1) fell outside TRZ in our series, of which 2 reported transient sural nerve paraesthesia. Based on our results, TRZ clinically correlated with nerve injury (Chi square test, p=0.032). The other three patients who reported sural nerve paraesthesia but fell inside TRZ measured on average 10.4 mm from the landmark line (10.2, 10.4, 10.7 mm). However when we used the alternative method, they all fell outside the safe zone of this alternative line. Conclusion: Our results suggest that TRZ clinically correlated with nerve injury. However, the alternative line (where the safe zone is a window 5.6 mm anterior to this line) might be more accurate than the landmark line (where the safe zone is 11.2 ± 2.7 mm anterior to this line). More clinical studies with larger numbers might be required to confirm this.

scholarly journals Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

2020 ◽  
Author(s):  
Ichiro Tonogai ◽  
Koichi Sairyo ◽  
Yoshihiro Tsuruo Tsuruo
Keyword(s):  
External Iliac Artery ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Cadaveric Study ◽  
Medial Side ◽  
Calcaneal Osteotomy ◽  
Plantar Artery ◽  
Perpendicular Distance ◽  
Risk Of Rupture ◽  
Enhanced Computed Tomography

Abstract Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

Examination of Safe Zone to Avoid Injury of the Lateral Plantar Artery During Calcaneal Osteotomy: A Fresh Cadaveric Study

2020 ◽  
pp. 193864002096508
Author(s):  
Ichiro Tonogai ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
External Iliac Artery ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Cadaveric Study ◽  
Medial Side ◽  
Calcaneal Osteotomy ◽  
Plantar Artery ◽  
Perpendicular Distance ◽  
Hindfoot Deformities ◽  
Enhanced Computed Tomography

Background: Calcaneal osteotomy are used to treat various pathologies in the correction of hindfoot deformities. But lateral plantar artery (LPA) pseudoaneurysms have been reported following calcaneal osteotomy, and LPA pseudoaneurysms may be at risk for rupture. Although the vascular structures in close proximity to calcaneal osteotomies have variable courses and branching patterns, there is little information on safe zone for LPA during calcaneal osteotomy. The aims of this study were to identify the safety zone to avoid the LPA injury during calcaneal osteotomy. Methods: Enhanced computed tomography scans of 25 fresh cadaveric feet (male, n = 13; female, n = 12; mean age 79.0 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery. Line A is the landmark line and extends from the posterosuperior aspect of the calcaneal tuberosity to the plantar fascia origin, and the perpendicular distance between the LPA and line A at its closest point was measured on sagittal images. Results: The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 cases (8.0 %), the perpendicular distance between the LPA and line A at its closest point was very close, approximately 9 mm. In 18 of 25 feet (72.0%), the point where perpendicular distance from the line A to LPA is the closest was the bifurcation of one of the medial calcaneal branches from LPA, and in 7 feet in 25 feet (28.0%) feet the point where perpendicular distance from the line A to LPA is the closest was the trifurcation of LPA, medial plantar artery, and one of the medial calcaneal branches. Conclusions: Calcaneal osteotomy approximately more than 9 mm from the line A could injure the LPA in overpenetration into the medial aspect of tcalcaneal osteotomy. Completion of the osteotomy on the medial side should be performed with caution to avoid iatrogenic injury of the LPA. Levels of Evidence:: Level IV, Cadaveric study

scholarly journals Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 887
Author(s):  
Chul-Hyun Cho ◽  
Don-Kyu Kim ◽  
Du Hwan Kim
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Injury ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Axillary Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Shoulder Trauma ◽  
History Of

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

Analysis of lumbar plexopathies and nerve injury after lateral retroperitoneal transpsoas approach: diagnostic standardization

2013 ◽  
Vol 18 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Amir Ahmadian ◽  
Armen R. Deukmedjian ◽  
Naomi Abel ◽  
Elias Dakwar ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Nerve Injury ◽  
Lumbar Fusion ◽  
Sensory Nerve ◽  
Clinical Findings ◽  
Lumbar Plexus ◽  
Neurological Deficits ◽  
Nerve Injuries ◽  
Nerve Blocks ◽  
Transpsoas Approach

Object The minimally invasive lateral transpsoas approach has become an increasingly popular means of fusion. The most frequent complication is related to lumbar plexus nerve injuries; these can be diagnosed based on distribution of neurological deficit following the motor and/or sensory nerve injury. However, the literature has failed to provide a clinically relevant description of these complications. With accurate clinical diagnosis, spine practitioners can provide more precise prognostic and management recommendations to include observation, nerve blocks, neurodestructive procedures, medications, or surgical repair strategies. The purpose of this study was to standardize the clinical findings of lumbar plexopathies and nerve injuries associated with minimally invasive lateral retroperitoneal transpsoas lumbar fusion. Methods A thorough literature search of the MEDLINE database up to June 2012 was performed to identify studies that reported lumbar plexus and nerve injuries after the minimally invasive lateral retroperitoneal transpsoas approach. Included studies were assessed for described neurological deficits postoperatively. Studies that did attempt to describe nerve-related complications clinically were excluded. A clinically relevant assessment of lumbar plexus nerve injury was derived to standardize early diagnosis and outline prognostic implications. Results A total of 18 studies were selected with a total of 2310 patients; 304 patients were reported to have possible plexus-related complications. The incidence of documented nerve and/or root injury and abdominal paresis ranged from 0% to 3.4% and 4.2%, respectively. Motor weakness ranged from 0.7% to 33.6%. Sensory complications ranged from 0% to 75%. A lack of consistency in the descriptions of the lumbar plexopathies and/or nerve injuries as well as a lack of diagnostic paradigms was noted across studies reviewed. Sensory dermal zones were established and a standardized approach was proposed. Conclusions There is underreporting of postoperative lumbar plexus nerve injury and a lack of standardization of clinical findings of neural complications related to the minimally invasive lateral retroperitoneal transpsoas approach. The authors provide a diagnostic paradigm that allows for an efficient and accurate classification of postoperative lumbar plexopathies and nerve injuries.

Human motor endplate remodeling after traumatic nerve injury

2020 ◽  
pp. 1-8
Author(s):  
Ranjan Gupta ◽  
Justin P. Chan ◽  
Jennifer Uong ◽  
Winnie A. Palispis ◽  
David J. Wright ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Surgical Intervention ◽  
Linear Regression Analysis ◽  
Motor Endplate ◽  
Nerve Injuries ◽  
Denervated Muscle ◽  
Sequence Of Events ◽  
Human Motor ◽  
Denervated Muscles

OBJECTIVECurrent management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.METHODSA prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy.RESULTSImmunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = −0.92, R2 = 0.85, p = 0.001) and surface area (R = −0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury.CONCLUSIONSThis study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.

scholarly journals Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

2021 ◽  
Vol 22 (3) ◽  
pp. 1401
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana C. Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Small Sample ◽  
Therapeutic Options ◽  
Nerve Injuries ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

scholarly journals Permanent central synaptic disconnection of proprioceptors after nerve injury and regeneration. I. Loss of VGLUT1/IA synapses on motoneurons

2011 ◽  
Vol 106 (5) ◽  
pp. 2450-2470 ◽  
Author(s):  
Francisco J. Alvarez ◽  
Haley E. Titus-Mitchell ◽  
Katie L. Bullinger ◽  
Michal Kraszpulski ◽  
Paul Nardelli ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Cell Body ◽  
Peripheral Nerve Injury ◽  
Motor Coordination ◽  
Electrophysiological Study ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Ia Afferent ◽  
Axon Collaterals

Motor and sensory proprioceptive axons reinnervate muscles after peripheral nerve transections followed by microsurgical reattachment; nevertheless, motor coordination remains abnormal and stretch reflexes absent. We analyzed the possibility that permanent losses of central IA afferent synapses, as a consequence of peripheral nerve injury, are responsible for this deficit. VGLUT1 was used as a marker of proprioceptive synapses on rat motoneurons. After nerve injuries synapses are stripped from motoneurons, but while other excitatory and inhibitory inputs eventually recover, VGLUT1 synapses are permanently lost on the cell body (75–95% synaptic losses) and on the proximal 100 μm of dendrite (50% loss). Lost VGLUT1 synapses did not recover, even many months after muscle reinnervation. Interestingly, VGLUT1 density in more distal dendrites did not change. To investigate whether losses are due to VGLUT1 downregulation in injured IA afferents or to complete synaptic disassembly and regression of IA ventral projections, we studied the central trajectories and synaptic varicosities of axon collaterals from control and regenerated afferents with IA-like responses to stretch that were intracellularly filled with neurobiotin. VGLUT1 was present in all synaptic varicosities, identified with the synaptic marker SV2, of control and regenerated afferents. However, regenerated afferents lacked axon collaterals and synapses in lamina IX. In conjunction with the companion electrophysiological study [Bullinger KL, Nardelli P, Pinter MJ, Alvarez FJ, Cope TC. J Neurophysiol (August 10, 2011). doi:10.1152/jn.01097.2010], we conclude that peripheral nerve injuries cause a permanent retraction of IA afferent synaptic varicosities from lamina IX and disconnection with motoneurons that is not recovered after peripheral regeneration and reinnervation of muscle by sensory and motor axons.

Sign in / Sign up

Export Citation Format

Share Document