New Treatments for Spinal Nerve Root Avulsion Injury

✓ Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.

Download Full-text

Recovery of motor function after spinal nerve root avulsion repaired by re-implantation and other surgical procedures

Clinical Neurophysiology ◽

10.1016/j.clinph.2006.07.250 ◽

2007 ◽

Vol 118 (5) ◽

pp. e161

Author(s):

M. Htut ◽

V.P. Misra ◽

P. Anand ◽

R. Birch ◽

T. Carlstedt

Keyword(s):

Motor Function ◽

Surgical Procedures ◽

Nerve Root ◽

Spinal Nerve ◽

Spinal Nerve Root ◽

Root Avulsion ◽

Nerve Root Avulsion ◽

Recovery Of Motor Function

Download Full-text

A comparative histological analysis of two models of nerve root avulsion injury in the adult rat

Neuropathology and Applied Neurobiology ◽

10.1111/j.1365-2990.2011.01176.x ◽

2011 ◽

Vol 37 (6) ◽

pp. 613-632 ◽

Cited By ~ 21

Author(s):

D. J. Chew ◽

T. Carlstedt ◽

P. J Shortland

Keyword(s):

Nerve Root ◽

Histological Analysis ◽

Root Avulsion ◽

Avulsion Injury ◽

Adult Rat ◽

Nerve Root Avulsion

Download Full-text

Pretreatment of nerve grafts with resveratrol improves axonal regeneration following replantation surgery for nerve root avulsion injury in rats

Restorative Neurology and Neuroscience ◽

10.3233/rnn-180844 ◽

2018 ◽

Vol 36 (5) ◽

pp. 647-658 ◽

Cited By ~ 3

Author(s):

Hiroki Oda ◽

Souichi Ohta ◽

Ryosuke Ikeguchi ◽

Takashi Noguchi ◽

Yukitoshi Kaizawa ◽

...

Keyword(s):

Nerve Root ◽

Axonal Regeneration ◽

Root Avulsion ◽

Avulsion Injury ◽

Nerve Grafts ◽

Nerve Root Avulsion

Download Full-text

PLGA-PEG-PLGA hydrogel with NEP1-40 promotes the functional recovery of brachial plexus root avulsion in adult rats

PeerJ ◽

10.7717/peerj.12269 ◽

2021 ◽

Vol 9 ◽

pp. e12269

Author(s):

Wenlai Guo ◽

Bingbing Pei ◽

Zehui Li ◽

Xiao Lan Ou ◽

Tianwen Sun ◽

...

Keyword(s):

Brachial Plexus ◽

Functional Recovery ◽

Rat Model ◽

Nerve Root ◽

Axonal Regeneration ◽

Biceps Brachii ◽

Nerve Tissue ◽

Root Avulsion ◽

Avulsion Injury ◽

Nerve Root Avulsion

Adult brachial plexus root avulsion can cause serious damage to nerve tissue and impair axonal regeneration, making the recovery of nerve function difficult. Nogo-A extracellular peptide residues 1-40 (NEP1-40) promote axonal regeneration by inhibiting the Nogo-66 receptor (NgR1), and poly (D, L-lactide-co-glycolide)-poly (ethylene glycol)-poly (D, L-lactide-co-glycolide) (PLGA-PEG-PLGA) hydrogel can be used to fill in tissue defects and concurrently function to sustain the release of NEP1-40. In this study, we established an adult rat model of brachial plexus nerve root avulsion injury and conducted nerve root replantation. PLGA-PEG-PLGA hydrogel combined with NEP1-40 was used to promote nerve regeneration and functional recovery in this rat model. Our results demonstrated that functional recovery was enhanced, and the survival rate of spinal anterior horn motoneurons was higher in rats that received a combination of PLGA-PEG-PLGA hydrogel and NEP1-40 than in those receiving other treatments. The combined therapy also significantly increased the number of fluorescent retrogradely labeled neurons, muscle fiber diameter, and motor endplate area of the biceps brachii. In conclusion, this study demonstrates that the effects of PLGA-PEG-PLGA hydrogel combined with NEP1-40 are superior to those of other therapies used to treat brachial plexus nerve root avulsion injury. Therefore, future studies should investigate the potential of PLGA-PEG-PLGA hydrogel as a primary treatment for brachial plexus root avulsion.

Download Full-text

Diagnosis of nerve root avulsion injuries in adults with traumatic brachial plexopathies: MRI compared with CT myelography

South African Journal of Radiology ◽

10.4102/sajr.v19i1.779 ◽

2015 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ewoudt Van der Linde ◽

Vanesha Naidu ◽

Ayesha Mitha ◽

Antoine Rocher

Keyword(s):

Sensitivity And Specificity ◽

Nerve Root ◽

Gold Standard ◽

Spinal Nerve ◽

Distinct Advantage ◽

Root Avulsion ◽

Patient Discomfort ◽

Tissue Contrast ◽

Nerve Root Avulsion ◽

Magnetic Resonance Imaging Mri

Background: Computed tomography myelography (CTM) has been broadly adopted as the ‘gold standard’ imaging technique in the diagnosis of nerve root avulsion injuries in traumatic brachial plexopathies. CTM has the distinct advantage of better spatial resolution than magnetic resonance imaging (MRI); however, this technique is invasive and can result in significant patient discomfort. MRI, therefore, seems relatively more advantageous as it is less invasive (requires no lumbar puncture), lacks radiation exposure, has no adverse reactions related to intrathecal contrast agents and confers excellent soft-tissue contrast. Objectives: To compare the sensitivity and specificity of MRI with CTM in the diagnosis of preganglionic nerve root avulsion injuries in adults with traumatic brachial plexopathies at the Inkosi Albert Luthuli Central Hospital.Method: A retrospective comparative analysis was performed on 16 adult patients with traumatic preganglionic brachial plexopathies who underwent both MRI and CTM at Inkosi Albert Luthuli Central Hospital. Radiologists experienced in both CTM and MRI interpreted the data and a comparison was made using CTM as the gold standard. Results: The sensitivity and specificity for MRI detecting preganglionic nerve root avulsion injuries and pseudomeningoceles was 82% and 100% respectively. The interobserver agreement between CTM and MRI for the detection of preganglionic nerve root avulsion injuries was 81.25% (Kappa = 0.77) and 87.5% (Kappa = 0.84) for the detection of pseudomeningoceles. Conclusion: MRI was as sensitive as CTM at detecting preganglionic nerve root avulsion injuries and pseudomeningoceles of spinal nerve roots C7–T1 of the brachial plexus. Some mild discrepancies existed at the C5 and C6 nerve root levels. Owing to the invasiveness of the procedure and resultant patient discomfort, CTM should be reserved for complicated cases or for patients with contraindications to MRI.

Download Full-text