Motoneuron survival after chronic and sequential peripheral nerve injuries in the rat

Object Surgical repair of peripheral nerves following chronic nerve injury is associated with poor axonal regeneration and outcome. An underlying possibility is that chronic injuries may increase motoneuron cell death. The hypothesis that substantial motoneuron death follows chronic and sequential nerve injuries was tested in adult rats in this study. Methods Thirty adult male Lewis rats underwent bilateral multistage surgeries. At initial surgery, Fast Blue (FB) tracer was injected at a nerve-crush injury site in the right control femoral motor nerve. The left femoral motor nerve was transected at the same level and either capped to prevent regeneration (Group 1), or repaired to allow axonal regeneration and reinnervation of the target quadriceps muscle (Group 2) (15 rats in each group). After 8 weeks in 6 rats/group, the left femoral nerve was cut and exposed to FB just proximal to prior nerve capping or repair and the rats were evaluated for FB-labeled motoneuron counts bilaterally in the spinal cord (this was considered survival after initial injury). In the remaining 9 animals/group, the left nerve was recut (sequential injury), exposed to FB, and repaired to a fresh distal saphenous nerve stump to permit axonal regeneration. Following another 6 weeks, Fluoro-Gold, a second retrograde tracer, was applied to the cut distal saphenous nerve. This allowed us to evaluate the number of motoneurons that survived (maintained FB labeling) and the number of motoneurons that survived but that also regenerated axons (double labeled with FB and Fluoro-Gold). Results A mean number of 350 and 392 FB-labeled motoneurons were found after 8 weeks of nerve injury on the right and the left sides, respectively. This indicated no significant cell death due to initial nerve injury alone. A similar number (mean 390) of motoneurons were counted at final end point at 14 weeks, indicating no significant cell death after sequential and chronic nerve injury. However, only 50% (mean 180) of the surviving motoneurons were double labeled, indicating that only half of the population regenerated their axons. Conclusions The hypothesis that significant motoneuron cell death occurs after chronic and or sequential nerve injury was rejected. Despite cell survival, only 50% of motoneurons are capable of exhibiting a regenerative response, consistent with our previous findings of reduced regeneration after chronic axotomy.

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Motor nerve injuries following the minimally invasive lateral transpsoas approach

Journal of Neurosurgery Spine ◽

10.3171/2012.5.spine1288 ◽

2012 ◽

Vol 17 (3) ◽

pp. 227-231 ◽

Cited By ~ 84

Author(s):

Kevin S. Cahill ◽

Joseph L. Martinez ◽

Michael Y. Wang ◽

Steven Vanni ◽

Allan D. Levi

Keyword(s):

Abdominal Wall ◽

Injury Risk ◽

Interbody Fusion ◽

Motor Nerve ◽

Femoral Nerve ◽

Nerve Injuries ◽

Disc Space ◽

Fusion Procedure ◽

Lateral Interbody Fusion ◽

Lateral Interbody

Object The aim of this study was to determine the incidence of motor nerve injuries during the minimally invasive lateral interbody fusion procedure at a single academic medical center. Methods A retrospective chart review of 118 patients who had undergone lateral interbody fusion was performed. Both inpatient and outpatient records were examined to identify any new postoperative motor weakness in the lower extremities and abdominal wall musculature that was attributable to the operative procedure. Results In the period from 2007 to 2011 the lateral interbody fusion procedure was attempted on 201 lumbar intervertebral disc levels. No femoral nerve injuries occurred at any disc level other than the L4–5 disc space. Among procedures involving the L4–5 level there were 2 femoral nerve injuries, corresponding to a 4.8% injury risk at this level as compared with a 0% injury risk at other lumbar spine levels. Five patients (4.2%) had postoperative abdominal flank bulge attributable to injury to the abdominal wall motor innervation. Conclusions The overall incidence of femoral nerve injury after the lateral transpsoas approach was 1.7%; however, the level-specific incidence was 4.8% for procedures performed at the L4–5 disc space. Approximately 4% of patients had postoperative abdominal flank bulge. Surgeons will be able to minimize these motor nerve injuries through judicious use of the procedure at the L4–5 level and careful attention to the T-11 and T-12 motor nerves during exposure and closure of the abdominal wall.

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Series of Cases with Iatrogenic Nerve Injury

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v28i2.5373 ◽

1970 ◽

Vol 28 (2) ◽

pp. 121-124

Author(s):

Selina Daisy ◽

Quazi Deen Mohammad ◽

Azharul Hoque ◽

Badrul Alam ◽

Badrul Haque ◽

...

Keyword(s):

Sciatic Nerve ◽

Peripheral Nerve ◽

Nerve Injury ◽

Femoral Nerve ◽

Accessory Nerve ◽

Nerve Injuries ◽

Sacral Plexus ◽

Iatrogenic Injuries ◽

Iatrogenic Nerve Injury ◽

Femoral Nerve Injury

After introduction of EMG at Dhaka Medical Collage onJanuary 01, 2006, a total of 415 cases referred to EMGlaboratory for electrophysiological evaluation over a periodof two years(January 01, 2006 to December 31, 2007). Among these, 7cases diagnosed as iatrogenic nerve injuries. The subtypesof iatrogenic nerve injuries were:1. Accessory nerve injury: three, 2. Femoral nerve injury:one, 3. Sciatic nerve injury: one,4. Lumbar sacral plexus injury: one, 5. Combined sciaticand femoral nerve injury: oneIn order to investigate the causes, diagnosis & preventionof iatrogenic nerve injuries; we have reviewed 7 cases ofiatrogenic nerve injuries. The peripheral nerve injuriesoccurred due to lack of proper awareness of medicalpersonals. These injuries are iatrogenic injuries so it isuseful to review the mode of injuries and means ofprevention.DOI: 10.3329/jbcps.v28i2.5373J Bangladesh Coll Phys Surg 2010; 28: 121-124

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Saphenous nerve entrapment manifested as proximal cruralgia

Sao Paulo Medical Journal ◽

10.1590/s1516-31801997000500008 ◽

1997 ◽

Vol 115 (5) ◽

pp. 1553-1554 ◽

Cited By ~ 1

Author(s):

João Neves Camargo Júnior ◽

Anamarli Nucci

Keyword(s):

Myofascial Pain ◽

Femoral Nerve ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Primary Lesion ◽

Saphenous Nerve ◽

Medial Aspect ◽

Correct Treatment ◽

The Right ◽

Pain Distribution

A 16 year old boy had continuous pain in the right testis, groin, and the medial aspect of the thigh and knee for 16 months.The onset of symptoms was acute and pain distribution included a retrograde area in relation to the entrapment site. Tinel's sign was the clue for diagnosis. Diagnosis was confirmed at operation and division of the aponeurosis of Hunter's canal relieved the symptoms for three days. A second surgical exploration, proximal to the former one, was performed after five months.The right femoral nerve was found normal. This new operation was therapeutically ineffective. Causes of pain distribution and relapsed pain are discussed. The relapse was attributed to myofascial pain syndrome. This diagnosis should be considered independently of the correct treatment of the primary lesion.

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Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2016.01.026 ◽

2016 ◽

Vol 54 (4) ◽

pp. 362-365 ◽

Cited By ~ 7

Author(s):

D.C. Bowe ◽

E.A. Gruber ◽

N.M.H. McLeod

Keyword(s):

Nerve Injury ◽

Orthognathic Surgery ◽

Motor Nerve ◽

Nerve Injuries

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P497: Saphenous nerve somatosensory evoked potentials (SSEP) monitoring during lateral interbody fusion (LIF) in preventing femoral nerve injury

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50594-9 ◽

2014 ◽

Vol 125 ◽

pp. S182

Author(s):

L. Mnatsakanyan ◽

S.S. Bederman ◽

H. Guillen ◽

D. Yanni

Keyword(s):

Evoked Potentials ◽

Nerve Injury ◽

Somatosensory Evoked Potentials ◽

Interbody Fusion ◽

Femoral Nerve ◽

Saphenous Nerve ◽

Lateral Interbody Fusion ◽

Femoral Nerve Injury ◽

Lateral Interbody

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Acellular Nerve Allografts in Major Peripheral Nerve Repairs: An Analysis of Cases Presenting With Limited Recovery

Hand ◽

10.1177/15589447211003175 ◽

2021 ◽

pp. 155894472110031

Author(s):

Blair R. Peters ◽

Matthew D. Wood ◽

Daniel A. Hunter ◽

Susan E. Mackinnon

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Ulnar Nerve ◽

Current Literature ◽

Axonal Regeneration ◽

Large Diameter ◽

Nerve Injuries ◽

Myelinated Axons ◽

Acellular Nerve Allograft ◽

Ulnar Nerve Injury

Background: Acellular nerve allografts have been used successfully and with increasing frequency to reconstruct nerve injuries. As their use has been expanded to treat longer gap, larger diameter nerve injuries, some failed cases have been reported. We present the histomorphometry of 5 such cases illustrating these limitations and review the current literature of acellular nerve allografts. Methods: Between 2014 and 2019, 5 patients with iatrogenic nerve injuries to the median or ulnar nerve reconstructed with an AxoGen AVANCE nerve allograft at an outside hospital were treated in our center with allograft excision and alternative reconstruction. These patients had no clinical or electrophysiological evidence of recovery, and allograft specimens at the time of surgery were sent for histomorphological examination. Results: Three patients with a median and 2 with ulnar nerve injury were included. Histology demonstrated myelinated axons present in all proximal native nerve specimens. In 2 cases, axons failed to regenerate into the allograft and in 3 cases, axonal regeneration diminished or terminated within the allograft. Conclusions: The reported cases demonstrate the importance of evaluating the length and the function of nerves undergoing acellular nerve allograft repair. In long length, large-diameter nerves, the use of acellular nerve allografts should be carefully considered.

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The Combined Use of Curcumin and Platelet-Rich Plasma Enhances Axonal Regeneration in Acute Nerve Injuries: An Experimental Study in a Rat Model

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1721562 ◽

2020 ◽

Author(s):

Abraham Zavala ◽

Peggy C. Martinez ◽

Geovanna G. Gutierrez ◽

Marino D. Vara ◽

Wieslawa De Pawlikowski

Keyword(s):

Rat Model ◽

Axonal Regeneration ◽

Platelet Rich Plasma ◽

Nerve Repair ◽

Control Group ◽

Albino Rats ◽

Nerve Injuries ◽

Group Iii ◽

Combined Use ◽

The Right

Abstract Introduction The aim of this study was to determine if the combined use of curcumin and platelet-rich plasma (PRP) improves the axonal regeneration process in acutely repaired nerve injuries. Materials and Methods The right sciatic nerves of 32 Holtzman albino rats were transected and immediately repaired. Four treatments were randomly allocated: (1) nerve repair only; (2) nerve repair + local PRP; (3) nerve repair + intraperitoneal curcumin; and (4) nerve repair + local PRP + intraperitoneal curcumin. Clinical (estimation of sciatic functional index) and electrophysiological outcomes were assessed 4 and 12 weeks after surgery, and histologic evaluations performed 12 weeks after surgery. Results Group IV (PRP + curcumin) resulted in significantly better outcomes across all the evaluation parameters, compared with the other three groups (p < 0.05). Additionally, when used as single adjuvants, both the curcumin (group III) and PRP (group II) groups showed significant improvement over the control group (p < 0.05). No significant differences were found between PRP and curcumin when used as sole adjuvants. Conclusion The combined administration of curcumin + PRP as adjuvants to nerve repair could enhance axonal regeneration in terms of clinical, electrophysiological, and histological parameters in a rat model of acute sciatic nerve injury.

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Femoral nerve transfers for restoring tibial nerve function: an anatomical study and clinical correlation: a report of 2 cases

Journal of Neurosurgery ◽

10.3171/2017.5.jns163076 ◽

2018 ◽

Vol 129 (4) ◽

pp. 1024-1033 ◽

Cited By ~ 3

Author(s):

Amy M. Moore ◽

Emily M. Krauss ◽

Rajiv P. Parikh ◽

Michael J. Franco ◽

Thomas H. Tung

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Tibial Nerve ◽

Plantar Flexion ◽

Femoral Nerve ◽

Saphenous Nerve ◽

Sciatic Nerve Injury ◽

Anatomical Landmarks ◽

Nerve Transfers ◽

Sensory Recovery

Sciatic nerve injuries cause debilitating functional impairment, particularly when the injury mechanism and level preclude reconstruction with primary grafting. The purpose of this study was to demonstrate the anatomical feasibility of nerve transfers from the distal femoral nerve terminal branches to the tibial nerve and to detail the successful restoration of tibial function using the described nerve transfers.Six cadaveric legs were dissected for anatomical analysis and the development of tension-free nerve transfers from femoral nerve branches to the tibial nerve. In 2 patients with complete tibial and common peroneal nerve palsies following sciatic nerve injury, terminal branches of the femoral nerve supplying the vastus medialis and vastus lateralis muscles were transferred to the medial and lateral gastrocnemius branches of the tibial nerve. Distal sensory transfer of the saphenous nerve to the sural nerve was also performed. Patients were followed up for lower-extremity motor and sensory recovery up to 18 months postoperatively.Consistent branching patterns and anatomical landmarks were present in all dissection specimens, allowing for reliable identification, neurolysis, and coaptation of donor femoral and saphenous nerve branches to the recipients. Clinically, the patients obtained Medical Research Council Grade 3 and 3+ plantar flexion by 18 months postoperatively. Improved strength was accompanied by improved ambulation in both patients and by a return to competitive sports in 1 patient. Sensory recovery was demonstrated by an advancing Tinel sign in both patients.This study illustrates the clinical success and anatomical feasibility of femoral nerve to tibial nerve transfers after proximal sciatic nerve injury.

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Saphenous Nerve Somatosensory-Evoked Potentials Monitoring During Lateral Interbody Fusion

Global Spine Journal ◽

10.1177/2192568220922979 ◽

2020 ◽

pp. 219256822092297

Author(s):

Nick Jain ◽

Ram Alluri ◽

Kevin Phan ◽

Daniel Yanni ◽

Andrew Alvarez ◽

...

Keyword(s):

Evoked Potentials ◽

Nerve Injury ◽

Somatosensory Evoked Potentials ◽

Interbody Fusion ◽

Femoral Nerve ◽

Saphenous Nerve ◽

Lumbar Plexus ◽

Tubular Retractor ◽

Femoral Nerve Injury ◽

Lateral Interbody

Study Design.: Retrospective cohort study. Objectives: To clinically evaluate saphenous nerve somatosensory-evoked potentials (SSEPs) as a reliable and predictable way to detect upper lumbar plexus injury intraoperatively during lateral lumbar trans-psoas interbody fusion (LLIF). Methods: Saphenous nerve SSEPs were obtained by stimulation of inferior medial thigh with needle electrodes and recording from transcranial potentials. The primary outcome was measured by testing reproducibility of SSEPs at baseline, changes during the procedure, and relevance to standard modalities. Significant SSEP changes were compared with actual postoperative nerve complications. The sensitivity and specificity of saphenous SSEPs to detect postoperative lumbar plexus nerve injury was calculated. Results: A total of 62 patients were included in the study. Reliable saphenous SSEPs were recorded on the LLIF approach side in 52/62 patients. Persistent saphenous SSEP reduction of amplitude of >50% in 6 cases was observed during expansion of the tubular retractor or during the procedure. Two of 6 patients postoperatively had femoral nerve sensory deficits, and 5 of 6 patients had mild femoral nerve motor weakness, all of which resolved at an average of 12 weeks postoperatively (range 2-24 weeks). One patient had saphenous SSEP changes but demonstrated intraoperative recovery and had no postoperative clinical deficits. Saphenous SSEPs demonstrated 52% to 100% sensitivity and 90% to 100% specificity for detecting postoperative femoral nerve complications. Conclusion: Saphenous SSEPs can be used to detect electrophysiological changes to prevent femoral nerve injury during LLIF. Intraoperative SSEP recovery after amplitude reduction or loss may be a prognostic factor for final clinical outcome.

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