First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

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Long-Term Follow-Up after the Sural Nerve Graft on the Injured Temporal Branch of the Facial Nerve: A Case Report

Archives of Hand and Microsurgery ◽

10.12790/ahm.2018.23.4.306 ◽

2018 ◽

Vol 23 (4) ◽

pp. 306

Author(s):

Jeong-Hyun Cheon ◽

Jae-Ho Chung ◽

Eul-Sik Yoon ◽

Byung-Il Lee ◽

Seung-Ha Park

Keyword(s):

Case Report ◽

Facial Nerve ◽

Sural Nerve ◽

Nerve Graft ◽

Long Term Follow Up ◽

Sural Nerve Graft

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Reconstruction of Sciatic Nerve Using Bilateral Vascularized Sural Nerve Grafts: A Case Report

Archives of Hand and Microsurgery ◽

10.12790/ahm.21.0125 ◽

2021 ◽

Author(s):

Si-Gyun Roh ◽

Jae Young Chun ◽

Nae-Ho Lee ◽

Jin Yong Shin ◽

Jong-Lim Kim

Keyword(s):

Case Report ◽

Sciatic Nerve ◽

Peripheral Nerve ◽

Sural Nerve ◽

Tumor Resection ◽

Nerve Graft ◽

Sensory Function ◽

Nerve Grafts ◽

Function Recovery ◽

Sural Nerve Graft

Injury of peripheral nerve may require reconstruction for motor and sensory function recovery. However, when the nerve defect is long, especially in the lower extremities, reconstruction with successful function recovery proved to be difficult. We documented a case of bilateral vascularized sural nerve graft repair of a large and long sciatic nerve defect following malignant tumor resection on posterior thigh. Although we were unable to achieve satisfactory outcomes in motor function recovery, we did accomplish some sensory function recovery.

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Long-Term Follow-Up Study of Peripheral Nerve Repair by Non-Nerve Tissues

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80204-x ◽

1996 ◽

Vol 21 (6) ◽

pp. 830-830

Author(s):

J-C. Liu

Keyword(s):

Peripheral Nerve ◽

Nerve Repair ◽

Muscle Membrane ◽

Peripheral Nerve Repair ◽

Muscle Graft ◽

Follow Up Study ◽

Long Term Follow Up ◽

Empty Tube

This paper reported a long-term follow-up of seven cases (eight nerves) with peripheral nerve repair by non-nerve tissues. The injured nerves involved three median, two radial, one ulnar and one tibial nerves. These patients were treated 3 to 10 months after injuries. In five cases, pedicled muscles grafts were used to repair nerve gaps from 3 to 6 cm. Follow-up between 4 years and 10 months and 6 years and 8 months showed functional recovery ranged from MOS1 to M2 + S3. Two cases of nerve gaps 3 and 4 cm in length repaired by empty muscle membrane tubes recovered to M3S4 and M4S4. Liu concluded that pedicled muscle graft is not an ideal substitute for nerve graft. They peculated that inner structures in the muscle graft prevented growth of regenerating axons, which made the graft not function as effectively as an empty tube. One should be cautious in using non-nerve tissues to repair peripheral nerve gaps.

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Peripheral Nerve Field Stimulation for the Treatment of Chronic Low Back Pain: Preliminary Results of Long-Term Follow-up: A Case Series

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.2007.00116.x ◽

2007 ◽

Vol 10 (3) ◽

pp. 279-290 ◽

Cited By ~ 75

Author(s):

Richard M. Paicius ◽

Clifford A. Bernstein ◽

Cheryl Lempert-Cohen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Peripheral Nerve ◽

Case Series ◽

Field Stimulation ◽

Low Back ◽

Long Term Follow Up ◽

Peripheral Nerve Field Stimulation

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Age does not affect the outcome after digital nerve repair in children – A retrospective long term follow up

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.06.012 ◽

2017 ◽

Vol 22 (5) ◽

pp. 915-918 ◽

Cited By ~ 1

Author(s):

Hans-Eric Rosberg ◽

Derya Burcu Hazer Rosberg ◽

Illugi Birkisson ◽

Lars B. Dahlin

Keyword(s):

Nerve Repair ◽

Digital Nerve ◽

Long Term Follow Up

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Lack of correlation between spinal microgliosis and long-term development of tactile hypersensitivity in two different sciatic nerve crush injury

Molecular Pain ◽

10.1177/17448069211011326 ◽

2021 ◽

Vol 17 ◽

pp. 174480692110113

Author(s):

Hyoung Woo Kim ◽

Chan Hee Won ◽

Seog Bae Oh

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Sciatic Nerve ◽

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Sensory Function ◽

Crush Injury ◽

Sciatic Nerve Crush

Microglia activation following peripheral nerve injury has been shown to contribute to central sensitization of the spinal cord for the development of neuropathic pain. In a recent study, we reported that the amount of nerve damage does not necessarily correlate with chronic pain development. Here we compared the response of spinal microglia, using immunohistochemistry as a surrogate of microglial activation, in mice with two different types of crush injury of the sciatic nerve. We confirmed that incomplete crush of the sciatic nerve (partial crush injury, PCI) resulted in tactile hypersensitivity after the recovery of sensory function (15 days after surgery), whereas the hypersensitivity was not observed after the complete crush (full crush injury, FCI). We observed that immunoreactivity for Iba-1, a microglial marker, was greater in the ipsilateral dorsal horn of lumbar (L4) spinal cord of mice 2 days after FCI compared to PCI, positively correlating with the intensity of crush injury. Ipsilateral Iba-1 reactivity was comparable between injuries at 7 days with a significant increase compared to the contralateral side. By day 15 after injury, ipsilateral Iba-1 immunoreactivity was much reduced compared to day 7 and was not different between the groups. Our results suggest that the magnitude of the early microgliosis is dependent on injury severity, but does not necessarily correlate with the long-term development of chronic pain-like hypersensitivity after peripheral nerve injury.

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Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

SAGE Open Medicine ◽

10.1177/2050312116645731 ◽

2016 ◽

Vol 4 ◽

pp. 205031211664573 ◽

Cited By ~ 9

Author(s):

Harry Göransson ◽

Olli V Leppänen ◽

Martti Vastamäki

Keyword(s):

Nerve Repair ◽

Trapezius Muscle ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Shoulder Abduction ◽

Spinal Accessory ◽

Long Term Follow Up ◽

Direct Nerve

Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected.

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Retrospective Study of Surgical Repair of Gunshot Injuries of Peripheral Nerves.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i2.48 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Ridvan Alimehmeti ◽

Gramoz Brace ◽

Ermira Pajaj ◽

Arba Cecia ◽

Thoma Kalefi ◽

...

Keyword(s):

Retrospective Study ◽

Brachial Plexus ◽

Peripheral Nerves ◽

Surgical Repair ◽

Nerve Repair ◽

Locomotor Apparatus ◽

Severity Of Injury ◽

Long Term Follow Up

Background: Shotgun injuries of the peripheral nerves are presented frequently during the last decades at the Service of Neurosurgery of UHC “Mother Theresa” in Tirana. In such cases the surgical repair of brachial plexus and peripheral nerves constitutes a challenge with relation to difficulties related with mechanism of injury, coexistence of other vascular damage, bone, soft tissue and visceral lesions. Materials and methods: A retrospective study of operated cases with shotgun injuries treated in our Department from 1997 to 2012 was conducted getting information from clinical charts, surgical registries, intraoperative photos and videos of the surgical repair of peripheral nerves. We performed a thorough analysis of the most influencing factors of surgical outcome such as: age, severity of injury, site of injury with relation to the innervated muscles, type of necessary nerve repair, presence of causalgia before operation, concomitant compromise of vascularization and/or locomotor apparatus. Follow-up of the patient was conducted through out-patient visits and phone interviews going back 10 years from surgical repair. Results: 68 cases operated for shotgun injury of brachial plexus or peripheral nerves were revised. There were different ages and both sexes involved. The type of nerve repair went from interfascicular neurolysis to direct end-to-end microsuture and nerve grafting. Timely repair of the nerve injury proved to be yielding better result than late repair in terms of pain relief and sensory motor improvement of the preoperative neurological deficit. The degree and the quality of improvement after surgery is related to the type of repair (neurolysis improves better and faster than grafting), the distance from site of injury to the effector muscle (the longer the distance more time it takes for the function to recover). The recovery of the brachial plexus was followed up for many years and further surgery proved to be necessary and of further improvement. Conclusions: From our long term experience dealing with surgical repair of shotgun injury of peripheral nerves we have learnt that early surgical repair is more efficacious in treating pain and gives better results in terms of motor and sensitive recovery than six months after injury as it was usually done. Long term follow-up is necessary to help with further surgery in case of distal decompressive surgery in anatomical tunnels.

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