Brachial plexus repair by peripheral nerve grafts directly into the spinal cord in rats

✓ Over the years, peripheral nerve grafts, a favorable environment for the support of axonal elongation, have attracted interest as a possible means of promoting spinal cord repair. In the experiments described here, rats underwent an avulsion injury of the brachial plexus, and the musculocutaneous nerve was repaired by direct insertion of peripheral nerve grafts into the spinal cord. After varying postoperative periods, the rats were submitted to a series of behavioral tests to evaluate forelimb and hindlimb function. They also underwent retrograde double-labeling studies. Nerve grafts were harvested and processed for electronic microscopy. The biceps muscle was removed and weighed and its histology studied. After surgery, central axons effectively regenerated about 65 mm along the peripheral nerve grafts, restoring normal active elbow flexion. Forelimb movements were well coordinated in both voluntary and automatic activities. Clinical investigations showed that there were no side effects in the ipsilateral forepaw, contralateral forelimb, or either hindlimb. Regenerating axons stemmed from original motoneurons, foreign motoneurons, and even antagonist motoneurons, but this did not impair function. Ganglionic neurons from adjacent roots also sent processes to the peripheral nerve grafts.

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Peripheral nerve grafts promoting central nervous system regeneration after spinal cord injury in the primate

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.2.0197 ◽

2002 ◽

Vol 96 (2) ◽

pp. 197-205 ◽

Cited By ~ 16

Author(s):

Allan D. O. Levi ◽

Hector Dancausse ◽

Xiuming Li ◽

Suzanne Duncan ◽

Laura Horkey ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Spinal Cord Injury ◽

Nervous System ◽

Peripheral Nerve ◽

Content Type ◽

Nerve Grafts ◽

Cord Injury ◽

Peripheral Nerve Grafts ◽

Fine Print

Object. Partial restoration of hindlimb function in adult rats following spinal cord injury (SCI) has been demonstrated using a variety of transplantation techniques. The purpose of the present study was twofold: 1) to determine whether strategies designed to promote regeneration in the rat can yield similar results in the primate; and 2) to establish whether central nervous system (CNS) regeneration will influence voluntary grasping and locomotor function in the nonhuman primate. Methods. Ten cynomologus monkeys underwent T-11 laminectomy and resection of a 1-cm length of hemispinal cord. Five monkeys received six intercostal nerve autografts and fibrin glue containing acidic fibroblast growth factor (2.1 µg/ml) whereas controls underwent the identical laminectomy procedure but did not receive the nerve grafts. At 4 months postgrafting, the spinal cord—graft site was sectioned and immunostained for peripheral myelin proteins, biotinylated dextran amine, and tyrosine hydroxylase, whereas the midpoint of the graft was analyzed histologically for the total number of myelinated axons within and around the grafts. The animals underwent pre- and postoperative testing for changes in voluntary hindlimb grasping and gait. Conclusions. 1) A reproducible model of SCI in the primate was developed. 2) Spontaneous recovery of the ipsilateral hindlimb function occurred in both graft- and nongraft—treated monkeys over time without evidence of recovering the ability for voluntary tasks. 3) Regeneration of the CNS from proximal spinal axons into the peripheral nerve grafts was observed; however, the grafts did not promote regeneration beyond the lesion site. 4) The grafts significantly enhanced (p < 0.0001) the regeneration of myelinated axons into the region of the hemisected spinal cord compared with the nongrafted animals.

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Brachial plexus repair by peripheral nerve grafts directly implanted into the contralateral spinal cord

Restorative Neurology and Neuroscience ◽

10.3233/rnn-1997-11402 ◽

1997 ◽

Vol 11 (4) ◽

pp. 189-194

Author(s):

Jayme Augusto Bertelli ◽

Madjid Taleb ◽

Jean-Claude Mira ◽

Joao Batista Calixto ◽

Lina Kassar

Keyword(s):

Spinal Cord ◽

Peripheral Nerve ◽

Brachial Plexus ◽

Nerve Grafts ◽

Brachial Plexus Repair ◽

Peripheral Nerve Grafts

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Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons

Journal of Neurosurgery ◽

10.3171/jns.2004.101.3.0365 ◽

2004 ◽

Vol 101 (3) ◽

pp. 365-376 ◽

Cited By ~ 96

Author(s):

Allan J. Belzberg ◽

Michael J. Dorsi ◽

Phillip B. Storm ◽

John L. Moriarity

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Surgical Intervention ◽

Nerve Repair ◽

Nerve Transfer ◽

Elbow Flexion ◽

Medical Community ◽

Shoulder Abduction ◽

Content Type ◽

Fine Print

Object. Brachial plexus injuries (BPIs) are often devastating events that lead to upper-extremity paralysis, rendering the limb a painful extraneous appendage. Fortunately, there are several nerve repair techniques that provide restoration of some function. Although there is general agreement in the medical community concerning which patients may benefit from surgical intervention, the actual repair technique for a given lesion is less clear. The authors sought to identify and better define areas of agreement and disagreement among experienced peripheral nerve surgeons as to the management of BPIs. Methods. The authors developed a detailed survey in two parts: one part addressing general issues related to BPI and the other presenting four clinical cases. The survey was mailed to 126 experienced peripheral nerve physicians and 49 (39%) participated in the study. The respondents represent 22 different countries and multiple surgical subspecialties. They performed a mean of 33 brachial plexus reconstructions annually. Areas of significant disagreement included the timing and indications for surgical intervention in birth-related palsy, treatment of neuroma-in-continuity, the best transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for motor neurotization, and the use of distal or proximal coaptation during nerve transfer. Conclusions. Experienced peripheral nerve surgeons disagree in important ways as to the management of BPI. The decisions made by the various treating physicians underscore the many areas of disagreement regarding the treatment of BPI, including the diagnostic approach to defining the injury, timing of and indications for surgical intervention in birth-related palsy, the treatment of neuroma-in-continuity, the choice of nerve transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for neurotization, and the use of distal or proximal coaptation during nerve transfer.

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Faculty Opinions recommendation of Peripheral nerve grafts promoting central nervous system regeneration after spinal cord injury in the primate.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1008326.177322 ◽

2002 ◽

Author(s):

Mark Tuszynski

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Spinal Cord Injury ◽

Nervous System ◽

Peripheral Nerve ◽

Nerve Grafts ◽

Cord Injury ◽

Peripheral Nerve Grafts

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Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0770 ◽

2004 ◽

Vol 101 (5) ◽

pp. 770-778 ◽

Cited By ~ 38

Author(s):

Jayme Augusto Bertelli ◽

Marcos Flávio Ghizoni

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Phrenic Nerve ◽

Cranial Nerve ◽

External Rotation ◽

Elbow Flexion ◽

Content Type ◽

Nerve Transfers ◽

Contralateral Motor ◽

Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

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