Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

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Spinal cord bypass surgery using peripheral nerve transfers: review of translational studies and a case report on its use following complete spinal cord injury in a human

Neurosurgical FOCUS ◽

10.3171/foc.2009.26.2.e6 ◽

2009 ◽

Vol 26 (2) ◽

pp. E6 ◽

Cited By ~ 16

Author(s):

Jeffrey S. Oppenheim ◽

Daniel E. Spitzer ◽

Christopher J. Winfree

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Peripheral Nerve ◽

Intercostal Nerve ◽

Nerve Fibers ◽

Sensory Function ◽

Nerve Transfers ◽

Promising Therapeutic Approach ◽

Cord Injury ◽

Complete Spinal Cord Injury

Spinal cord injury has been studied in a variety of in vitro and in vivo animal models. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into the spinal cord below the level of injury. A model of spinal cord injury in rodents has shown the growth of peripheral nerve fibers into the spinal cord, with the subsequent development of functional synaptic connections and limb movement. The authors of this paper are currently developing a similar model in felines to assess the cortical control of these novel repair pathways. In an effort to determine whether these neurotization techniques could translate to spinal cord injury in humans, the authors treated a patient by using intercostal nerve transfer following complete acute spinal cord injury. The case presented details a patient with paraplegia who regained partial motor and sensory activity following the transfer of intercostal nerves, originating above the level of the spinal cord injury, into the spinal canal below the level of injury. The patient recovered some of his motor and sensory function. Notably, his recovered hip flexion showed respiratory variation. This finding raises the possibility that intercostal nerve transfers may augment neurological recovery after complete spinal cord injury.

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Stem Cell Therapy for Spinal Cord Injury

Neurotrauma ◽

10.1093/med/9780190279431.003.0035 ◽

2018 ◽

pp. 431-444

Author(s):

Ping Wu ◽

Mingliang Yang ◽

Yan Hao ◽

Shiqing Feng ◽

Jianjun Li

Keyword(s):

Spinal Cord ◽

Stem Cells ◽

Spinal Cord Injury ◽

Stem Cell ◽

Animal Studies ◽

Beneficial Effects ◽

Cord Injury ◽

Induced Pluripotent ◽

Spinal Cord Repair

Traumatic spinal cord injury (SCI), a devastating disorder that severely affects the quality of life in patients, currently lacks effective therapies. Stem cell research offers a promising option to facilitate spinal cord repair. This chapter provides an overview of the major types of stem cells being used in preclinical animal studies and clinical trials to treat SCI, including mesenchymal, neural, hematopoietic, embryonic, and induced pluripotent stem cells. The authors summarize the beneficial effects of stem cells as a potential new therapeutic approach, but also raise the concerns of the limitation and challenges the field is facing, and suggest future directions.

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Coping and Quality of Life in subjects with Spinal Cord Injury

PsycEXTRA Dataset ◽

10.1037/e572992012-489 ◽

2010 ◽

Author(s):

A. Teixeira ◽

F. Machado

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury

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The management of neurogenic bladder and quality of life in spinal cord injury

BJU International ◽

10.1111/j.1464-410x.2006.06395.x ◽

2006 ◽

Vol 98 (4) ◽

pp. 739-745 ◽

Cited By ~ 72

Author(s):

Ja Hyeon Ku

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Neurogenic Bladder ◽

Cord Injury

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Intravital Assessment of Cells Responses to Conducting Polymer-Coated Carbon Microfibres for Bridging Spinal Cord Injury

Cells ◽

10.3390/cells10010073 ◽

2021 ◽

Vol 10 (1) ◽

pp. 73

Author(s):

Bilal El Waly ◽

Vincent Escarrat ◽

Jimena Perez-Sanchez ◽

Jaspreet Kaur ◽

Florence Pelletier ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Immune Cell ◽

Two Photon ◽

Sensory Axons ◽

Promising Therapeutic Approach ◽

Cord Injury ◽

Biochemical Signals ◽

Coated Carbon ◽

Striking Effect

The extension of the lesion following spinal cord injury (SCI) poses a major challenge for regenerating axons, which must grow across several centimetres of damaged tissue in the absence of ordered guidance cues. Biofunctionalized electroconducting microfibres (MFs) that provide biochemical signals, as well as electrical and mechanical cues, offer a promising therapeutic approach to help axons overcome this blind journey. We used poly(3,4-ethylenedioxythiophene)-coated carbon MFs functionalized with cell adhesion molecules and growth factors to bridge the spinal cord after a partial unilateral dorsal quadrant lesion (PUDQL) in mice and followed cellular responses by intravital two-photon (2P) imaging through a spinal glass window. Thy1-CFP//LysM-EGFP//CD11c-EYFP triple transgenic reporter animals allowed real time simultaneous monitoring of axons, myeloid cells and microglial cells in the vicinity of the implanted MFs. MF biocompatibility was confirmed by the absence of inflammatory storm after implantation. We found that the sprouting of sensory axons was significantly accelerated by the implantation of functionalized MFs after PUDQL. Their implantation produced better axon alignment compared to random and misrouted axon regeneration that occurred in the absence of MF, with a most striking effect occurring two months after injury. Importantly, we observed differences in the intensity and composition of the innate immune response in comparison to PUDQL-only animals. A significant decrease of immune cell density was found in MF-implanted mice one month after lesion along with a higher ratio of monocyte-derived dendritic cells whose differentiation was accelerated. Therefore, functionalized carbon MFs promote the beneficial immune responses required for neural tissue repair, providing an encouraging strategy for SCI management.

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Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Spinal Cord ◽

10.1038/s41393-021-00659-9 ◽

2021 ◽

Author(s):

Florian Möller ◽

Rüdiger Rupp ◽

Norbert Weidner ◽

Christoph Gutenbrunner ◽

Yorck B. Kalke ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Independence ◽

Term Outcome ◽

Long Term Outcome ◽

Cord Injury ◽

Over Time

Abstract Study design Multicenter observational study. Objective To describe the long-term outcome of functional independence and quality of life (QoL) for individuals with traumatic and ischemic SCI beyond the first year after injury. Setting A multicenter study in Germany. Methods Participants of the European multicenter study about spinal cord injury (EMSCI) of three German SCI centers were included and followed over time by the German spinal cord injury cohort study (GerSCI). Individuals’ most recent spinal cord independence measure (SCIM) scores assessed by a clinician were followed up by a self-report (SCIM-SR) and correlated to selected items of the WHO short survey of quality of life (WHO-QoL-BREF). Results Data for 359 individuals were obtained. The average time passed the last clinical SCIM examination was 81.47 (SD 51.70) months. In total, 187 of the 359 received questionnaires contained a completely evaluable SCIM-SR. SCIM scores remained stable with the exception of reported management of bladder and bowel resulting in a slight decrease of SCIM-SR of −2.45 points (SD 16.81). SCIM-SR scores showed a significant correlation with the selected items of the WHO-QoL-BREF (p < 0.01) with moderate to strong influence. Conclusion SCIM score stability over time suggests a successful transfer of acquired independence skills obtained during primary rehabilitation into the community setting paralleled by positively related QoL measurements but bladder and bowel management may need special attention.

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