Repair of ruptured spinal nerve roots in a brachial plexus lesion

1995 ◽  
Vol 82 (4) ◽  
pp. 661-663 ◽  
Author(s):  
Thomas Carlstedt ◽  
Georg Norén
Keyword(s):  
Brachial Plexus ◽  
Spinal Nerve ◽  
Sensory Loss ◽  
Spinal Root ◽  
Nerve Roots ◽  
Content Type ◽  
Nerve Grafts ◽  
Functional Gain ◽  
Plexus Lesion ◽  
Intrinsic Hand Muscles

✓ A 22-year-old woman sustained a brachial plexus injury with supraganglionic rupture of the C-8 and T-1 nerve roots as a result of a traffic accident. She was operated on approximately 1 week following the accident. After a hemilaminectomy, the intradural defects in the ruptured roots were bridged with sural nerve grafts. Within 3 years she recovered function in all muscles supplied from the lower roots in the plexus except for the intrinsic hand muscles, but she had a persisting, complete sensory loss in the ulnar nerve distribution. The possibility for functional gain after repair of spinal root lesions in brachial plexus patients is discussed.

Lumbosacral intersegmental epispinal axons and ectopic ventral nerve rootlets

1987 ◽  
Vol 67 (2) ◽  
pp. 269-277 ◽  
Author(s):  
Wesley W. Parke ◽  
Ryo Watanabe
Keyword(s):  
Nerve Root ◽  
Sensory Nerve ◽  
Conus Medullaris ◽  
Spinal Nerve ◽  
Nerve Fibers ◽  
Ventral Horn ◽  
Spinal Nerve Roots ◽  
Nerve Roots ◽  
Content Type ◽  
Almost All

✓ An epispinal system of motor axons virtually covers the ventral and lateral funiculi of the human conus medullaris between the L-2 and S-2 levels. These nerve fibers apparently arise from motor cells of the ventral horn nuclei and join spinal nerve roots caudal to their level of origin. In all observed spinal cords, many of these axons converged at the cord surface and formed an irregular group of ectopic rootlets that could be visually traced to join conventional spinal nerve roots at one to several segments inferior to their original segmental level; occasional rootlets joined a dorsal nerve root. As almost all previous reports of nerve root interconnections involved only the dorsal roots and have been cited to explain a lack of an absolute segmental sensory nerve distribution, it is believed that these intersegmental motor fibers may similarly explain a more diffuse efferent distribution than has previously been suspected.

RESULTS OF END-TO-SIDE NERVE COAPTATION IN SEVERE OBSTETRIC BRACHIAL PLEXUS LESIONS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 656-663 ◽  
Author(s):  
Willem Pondaag ◽  
Alain Gilbert
Keyword(s):  
Brachial Plexus ◽  
Nerve Repair ◽  
Multiple Root ◽  
Axonal Outgrowth ◽  
Distal Stump ◽  
Nerve Grafts ◽  
Small Series ◽  
Obstetric Brachial Plexus ◽  
Plexus Lesion

Abstract OBJECTIVE Options for nerve repair are limited in brachial plexus lesions with multiple root avulsions because an insufficient number of proximal nerve stumps are available to serve as lead-out for nerve grafts. End-to-side nerve repair might be an alternative surgical technique for repair of such severe lesions. In this technique, an epineurial window is created in a healthy nerve, and the distal stump of the injured nerve is coapted to this site. Inconsistent results of end-to-side nerve repairs in traumatic nerve lesions in adults have been reported in small series. This article evaluates the results of end-to-side nerve repair in obstetric brachial plexus lesions and reviews the literature. METHODS A retrospective analysis was performed of 20 end-to-side repairs in 12 infants. Evaluation of functional recovery of the target muscle was performed after at least 2 years of follow up (mean, 33 mo). RESULTS Five repairs failed (25%). Seven times (35%) good function (Medical Research Council at least 3) of the target muscle occurred in addition to eight partial recoveries (40%). In the majority of patients, however, the observed recovery cannot be exclusively attributed to the end-to-side repair. The reinnervation may be based on axonal outgrowth through grafted or neurolyzed adjacent nerves. It seems likely that recovery was solely based on the end-to-side repair in only two patients. No deficits occurred in donor nerve function. CONCLUSION This study does not convincingly show that the end-to-side nerve repair in infants with an obstetric brachial plexus lesion is effective. Its use cannot be recommended as standard therapy.

Surgical treatment of lumbosacral plexus injuries

2004 ◽  
Vol 1 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Eva Maria Lang ◽  
Jörg Borges ◽  
Thomas Carlstedt
Keyword(s):  
Cauda Equina ◽  
Femoral Nerve ◽  
Severe Trauma ◽  
Lumbosacral Plexus ◽  
Spinal Root ◽  
Content Type ◽  
Spinal Nerves ◽  
Nerve Grafts ◽  
Nerve Transfers ◽  
Fine Print

Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment. Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed. Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.

Neurological and pathological effects of second lumbar spondylectomy and spinal column shortening in the dog

1975 ◽  
Vol 42 (1) ◽  
pp. 47-58 ◽  
Author(s):  
Daniel J. Yturraspe ◽  
William V. Lumb ◽  
Stuart Young ◽  
Harry A. Gorman
Keyword(s):  
Vertebral Column ◽  
Axonal Degeneration ◽  
Spinal Column ◽  
Lumbar Vertebra ◽  
Spinal Nerve ◽  
Spinal Nerve Roots ◽  
Loss Of Function ◽  
Nerve Roots ◽  
Content Type ◽  
Fine Print

✓ The second lumbar vertebra was surgically removed from 10 dogs, and the shortened vertebral column was stabilized by internal fixation with two types of plastic plates. Shortening of the spinal column was usually not associated with detectable loss of function or neurological deficit. Histological lesions, however, included widely disseminated axonal degeneration, gliosis, and atrophy of spinal nerve roots in the surgical area. The spinal cord adapted to shortening of the vertebral column by becoming intrinsically shorter, rather than by being displaced within the spinal canal.

Catamenial mononeuropathy and radiculopathy: a treatable neuropathic disorder

1998 ◽  
Vol 88 (5) ◽  
pp. 827-830 ◽  
Author(s):  
Eric L. Zager ◽  
Samantha M. Pfeifer ◽  
Mark J. Brown ◽  
Michael H. Torosian ◽  
David B. Hackney
Keyword(s):  
Treatment Options ◽  
Reproductive Age ◽  
Leg Pain ◽  
Sensory Loss ◽  
Pathological Examination ◽  
Nerve Roots ◽  
Content Type ◽  
Reproductive Age Women ◽  
Analgesic Medication ◽  
Fine Print

Object. The aim of this study was to investigate the indications and treatment options in patients with lower-extremity neuropathies and radiculopathies caused by endometriosis. Methods. The authors identified five patients whose symptoms included catamenial pain, weakness, and sensory loss involving the sciatic and femoral nerves and multiple lumbosacral nerve roots. Radiographic studies supported the diagnosis of catamenial neuropathy or radiculopathy, but definitive diagnosis depended on surgical and pathological examination. Treatment of symptoms, including physical therapy and a course of antiinflammatory or analgesic medication, was not helpful. Patients responded favorably to hormonal therapy. Laparoscopy or open exploration for extrapelvic lesions was performed for diagnosis or for treatment when hormone therapy failed. Pain and sensory symptoms responded well to therapy. Weakness improved, but never recovered completely. Conclusions. Catamenial neuropathy or radiculopathy should be considered when evaluating reproductive-age women with recurring focal neuropathic leg pain, weakness, and sensory loss.

Capillary hemangioma of the spinal cord

2000 ◽  
Vol 93 (1) ◽  
pp. 148-151 ◽  
Author(s):  
Federico Roncaroli ◽  
Bernd W. Scheithauer ◽  
William E. Krauss
Keyword(s):  
Spinal Cord ◽  
Spinal Nerve ◽  
Capillary Hemangioma ◽  
Benign Lesions ◽  
Spinal Cord Tumors ◽  
Nerve Roots ◽  
Intramedullary Tumors ◽  
Content Type ◽  
Presenting Symptoms ◽  
Feeding Vessels

✓ The authors describe the clinicopathological features of four cases of capillary hemangioma of the spinal cord. All occurred in adult patients. The presenting symptoms were similar to those of more common intramedullary tumors. Radiologically, they resemble other vascular spinal cord tumors. All patients underwent surgery, and the outcomes varied. Histologically, the lesions resembled capillary hemangioma of skin or of soft tissue that is composed of lobules of small capillaries with associated feeding vessels, all enveloped by a delicate fibrous capsule. Capillary hemangiomas of the central and peripheral nervous system are extremely rare. Although examples of these lesions have been described as occurring in the dura mater and in peripheral nerve, including spinal nerve roots, none has occurred within the spinal cord. Knowledge of their existence may help practitioners to avoid misdiagnosis of tumor and resultant overtreatment of these benign lesions.

A Fourth Type of Brachial Plexus Lesion: The Intermediate (C7) Palsy

1991 ◽  
Vol 16 (5) ◽  
pp. 492-494 ◽  
Author(s):  
G. A. BRUNELLI ◽  
G. R. BRUNELLI
Keyword(s):  
Brachial Plexus ◽  
Spinal Nerve ◽  
The Other ◽  
Brachial Plexus Lesion ◽  
Anterior Position ◽  
Different Types ◽  
New Type ◽  
Posterior Direction ◽  
Plexus Lesion ◽  
Total Type

A new type of brachial plexus lesion has been defined to be added to the classical types, i.e. the upper (Duchenne Erb), the lower (Dejerine Klumpke) and the total type. This new type is the intermediate palsy. The lesion is a partial involvement of the plexus, the predominant lesion of which involves C7 with a variable involvement of the upper or lower plexus. By observations during operation, and in cadavers, three different mechanisms are considered responsible for the three different types of lesion. A trauma with downwards traction principally involves the upper plexus. Trauma in abduction first involves the lower plexus while a traumatic force acting from an anterior to a posterior direction involves firstly and predominantly the C7 spinal nerve which is in an anterior position and less oblique than the other roots. Avulsion from the cord or rupture are possible. 33 cases have been observed.

Diabetic polyradiculopathy simulating lumbar disc disease

1984 ◽  
Vol 60 (1) ◽  
pp. 183-186 ◽  
Author(s):  
Leonard F. Hirsh
Keyword(s):  
Lumbar Disc ◽  
Spinal Nerve ◽  
Spinal Diseases ◽  
Endocrine Disorders ◽  
Disc Disease ◽  
Nerve Roots ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
The Common ◽  
Neurological Effects

✓ Most clinicians are aware of the common neurological effects of endocrine disorders. However, involvement of the spinal nerve roots is a poorly recognized complication of diabetes mellitus. Such involvement can closely simulate more common spinal diseases and thus lead to inappropriate therapy. Four cases of diabetic polyradiculopathy simulating lumbar disc disease are reported, and this distinctive entity is reviewed.

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