1
|
Cao J, Chang J, Wu C, Zhang S, Wang B, Yang K, Cao X, Sui T. Extradural contralateral S1 nerve root transfer for spastic lower limb paralysis. J Biomed Res 2023; 37:394-400. [PMID: 37750309 PMCID: PMC10541774 DOI: 10.7555/jbr.37.20230068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 09/27/2023] Open
Abstract
The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root (VR) to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis. Six formalin-fixed (three males and three females) cadavers were used. The VR of the contralateral S1 was transferred to the VR of the ipsilateral L5. The sural nerve was selected as a bridge between the donor and recipient nerve. The number of axons, the cross-sectional areas and the pertinent distances between the donor and recipient nerves were measured. The extradural S1 VR and L5 VR could be separated based on anatomical markers of the dorsal root ganglion. The gross distance between the S1 nerve root and L5 nerve root was 31.31 (± 3.23) mm in the six cadavers, while that on the diffusion tensor imaging was 47.51 (± 3.23) mm in 60 patients without spinal diseases, and both distances were seperately greater than that between the outlet of S1 from the spinal cord and the ganglion. The numbers of axons in the S1 VRs and L5 VRs were 13414.20 (± 2890.30) and 10613.20 (± 2135.58), respectively. The cross-sectional areas of the S1 VR and L5 VR were 1.68 (± 0.26) mm 2 and 1.08 (± 0.26) mm 2, respectively. In conclusion, transfer of the contralateral S1 VR to the ipsilateral L5 VR may be an anatomically feasible treatment option for unilateral spastic lower limb paralysis.
Collapse
Affiliation(s)
- Jiang Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jie Chang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chaoqin Wu
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Sheng Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Binyu Wang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Kaixiang Yang
- Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| |
Collapse
|
2
|
Extradural Contralateral Ventral Root Transfer to Treat Lower Limb Motor Dysfunction in Paraplegia. Spine (Phila Pa 1976) 2022; 47:1253-1258. [PMID: 35853170 DOI: 10.1097/brs.0000000000004373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/10/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Eight cadavers were included in this anatomical study. OBJECTIVE This study aimed to confirm the anatomical feasibility of extradural transfer of the contralateral T11 ventral root (VR) to the ipsilateral L2 level and the contralateral L1 VR to the ipsilateral L3 level to restore lower limb function in cases of paraplegia. SUMMARY OF BACKGROUND DATA Motor dysfunction due to hemiplegia significantly affects the daily life of patients. To date, unlike in cases of upper limb dysfunction, there are few studies on the surgical management of lower limb movement dysfunction. MATERIALS AND METHODS Eight cadavers were included in this study to confirm the feasibility of the nerve transfer. After separating the VR and dorsal root at each level, the VRs at the T11 and L1 levels were anastomosed with the VRs of L2 and L3, respectively. The length of the VRs of donor roots and the distance between the donor and recipient nerves were measured. H&E staining was performed to verify the number of axons and the cross-sectional area of the VRs. Lumbar x-rays of 60 healthy adults were used to measure the distance between the donor and recipient nerves. RESULTS After exposing the bilateral extradural each root, the VRs could be easily isolated from the whole root. The distance between the VRs of T11 and L2, L1, and L3 was significantly longer than the length of the donor nerve. Therefore, the sural nerve was used for grafting. The measurements performed on the lumbar x-rays of the 60 healthy adults confirmed the results. The number of axons and cross-sectional area of the VRs were measured. CONCLUSION Our study confirmed the anatomical feasibility of transferring the VRs of T11 to L2 and that of L1 to L3 to restore lower limb function in cases of hemiplegia. LEVEL OF EVIDENCE 5.
Collapse
|
3
|
A Cadaver Feasibility Study of Extradural Contralateral C7 Ventral Root Transfer Technique for Treating Upper Extremity Paralysis. Spine (Phila Pa 1976) 2022; 47:1248-1252. [PMID: 35867634 DOI: 10.1097/brs.0000000000004367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A total of 6 formalin-fixed cadavers were included in the cadaver feasibility study. OBJECTIVE The aim was to ascertain the anatomical feasibility of extradural contralateral C7 ventral root transfer technique by cervical posterior. SUMMARY OF BACKGROUND DATA Upper limb spastic hemiplegia is a common sequela after stroke. In our previous study, the authors established a method by transferring contralateral C7 dorsal and ventral roots to the corresponding C7 dorsal and ventral roots on the affected side in the cervical posterior. METHODS In the present study, six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. Experimental anastomosis in cadavers was conducted. The pertinent lengths of the extradural nerve roots were measured. The tissue structures surrounding regions between the extradural CC7 nerve roots and the vertebral artery were observed. The cervical magnetic resonance imaging scans of 60 adults were used to measure the distance between the donor and recipient nerves. RESULTS Experimental anastomosis showed that the distance between the donor and recipient nerves was approximately 1 cm; the short segment of the sural nerve needed bridging. The distance between both exit sites of the exit of the extradural dura mater was 33.57±1.55 mm. The length of the extradural CC7 ventral root was 22.00±0.98 mm. The ventral distance (vd) and the dorsal distance (dd) in males were 23.98±1.72 mm and 30.85±2.22 mm ( P <0.05), while those in females were 23.28±1.51 mm and 30.03±2.16 mm, respectively. C7 vertebral transverse process, ligaments, and other soft tissues were observed between the vertebral artery and the extradural C7 nerve root. CONCLUSION Under the premise of less trauma, our study shows that the extradural contralateral C7 ventral root transfer technique, in theory, yields better surgical results, including better recovery of motor function and complete preservation of sensory function. LEVEL OF EVIDENCE 5.
Collapse
|
4
|
Chen H, Cao J, Zhang S, Sui T, Yang K, Cao X. Application of Extradural Nerve Root Transfer in the Restoration of Lower Limb Function in Spinal Cord Injury: Hypothesis and a Cadaver Feasibility Study. Spine (Phila Pa 1976) 2021; 46:1363-1369. [PMID: 34559748 DOI: 10.1097/brs.0000000000004013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Two fresh-frozen and six formalin-fixed cadavers were included in the study. OBJECTIVE To ascertain whether transferring T9 or T11 ventral root (VR) to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function after spinal cord injury is anatomically feasible. SUMMARY OF BACKGROUND DATA Lower limb paralysis impairs the quality of the life and places burden on the whole society. However, no significant improvement in this area was achieved during recent years. METHODS In the present study, two fresh-frozen and six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. A limited laminectomy was performed to expose the T9-L3 extradural nerve roots. T9 and T10 VR were anastomosed to L2 and L3 VR respectively, or T11 and T12 VR were anastomosed to L2 and L3 VR respectively. The pertinent distances between the donor and recipient nerves were measured and H&E staining was used to detect the axon number and cross-section area of each VR. RESULTS The limited incision was performed to expose the T9-L3 nerve root. According to the anatomic landmark of dorsal root ganglion, each VR could be isolated from each extradural nerve root. The T9 or T11 VR needs sural nerve graft to be transferred to L2 VR, and T10 or T12 VR also needs a nerve bridge to connect to L3 VR. The nerve numbers of T9, T10, T11, T12, L2, and L3 VRs and the sural nerves were measured respectively. The cross-section areas of T9, T10, T11, T12, L2, and L3 VRs and sural nerves were measured respectively. CONCLUSION Our study suggested that application of transferring T9 or T11 VR to L2 VR and T10 or T12 VR to L3 VR in restoring lower limb function is anatomically feasible.Level of Evidence: 5.
Collapse
Affiliation(s)
- Hongtao Chen
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiang Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kaixiang Yang
- Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
5
|
Guo X, Feng Y, Sun T, Feng S, Tang J, Chen L, Cao X, Lin H, He X, Li M, Zhang Z, Yin G, Mei X, Huang H. Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version). JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Treatment of spinal cord injury (SCI) remains challenging. Considering the rapid developments in neurorestorative therapies for SCI, we have revised and updated the Clinical Therapeutic Guidelines for Neurorestoration in Spinal Cord Injury (2016 Chinese version) of the Chinese Association of Neurorestoratology (Preparatory) and China Committee of International Association of Neurorestoratology. Treatment of SCI is a systematic multimodal process that aims to improve survival and restore neurological function. These guidelines cover real-world comprehensive neurorestorative management of acute, subacute, and chronic SCI and include assessment and diagnosis, pre-hospital first aid, treatment, rehabilitation, and complication management.
Collapse
|
6
|
Extradural Contralateral C7 Nerve Root Transfer in a Cervical Posterior Approach for Treating Spastic Limb Paralysis: A Cadaver Feasibility Study. Spine (Phila Pa 1976) 2020; 45:E608-E615. [PMID: 31770316 DOI: 10.1097/brs.0000000000003349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Anatomic study in nine fresh-frozen cadavers. OBJECTIVE To confirm the anatomical feasibility of transferring the extradural ventral roots (VRs) and dorsal roots (DRs) of contralateral C7 nerves to those of the ipsilateral C7 nerves respectively through a cervical posterior approach. SUMMARY OF BACKGROUND DATA The contralateral C7 nerve root transfer technique makes breakthrough for treating spastic limb paralysis. However, its limitations include large surgical trauma and limited indications. METHODS Nine fresh-frozen cadavers (four females and five males) were placed prone, and the feasibility of exposing the bilateral extradural C7 nerve roots, separation of the extradural C7 VR and DR, and transfer of the VR and DR of the contralateral C7 to those of the ipsilateral C7 on the dural mater were assessed. The pertinent distances and the myelography results of each specimen were analyzed. The acetylcholinesterase (AChE) and antineurofilament 200 (NF200) double immunofluorescent staining were preformed to determine the nerve fiber properties. RESULTS A cervical posterior midline approach was made and the laminectomy was performed to expose the bilateral extradural C7 nerve roots. After the extradural C7 VR and DR are separated, the VR and DR of the contralateral C7 have sufficient lengths to be transferred to those of the ipsilateral C7 on the dural mater. The myelography results showed that the spinal cord is not compressed after the nerve anastomosis. The AChE and NF200 double immunofluorescent staining showed the distal ends of the contralateral C7 VRs were mostly motor nerve fibers, and the distal ends of the contralateral C7 DRs were mostly sensory nerve fibers. CONCLUSION Extradural contralateral C7 nerve root transfer in a cervical posterior approach for treating spastic limb paralysis is anatomically feasible. LEVEL OF EVIDENCE 5.
Collapse
|
7
|
Oshina M, Segawa T, Manabe N, Oshima Y, Tanaka S, Inanami H. Incidence, prognosis, and risk factors for bladder and bowel dysfunction due to incidental dural tears in lumbar microendoscopic surgery. Spine J 2020; 20:688-694. [PMID: 31863934 DOI: 10.1016/j.spinee.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the common occurrence of incidental dural tears, the incidence and prognosis of bladder and bowel dysfunction (BBD) due to incidental dural tears in lumbar spinal surgery are not well known because of the lack of reported cases. PURPOSE To analyze the incidence, prognosis, and risk factors for BBD after lumbar microendoscopic surgery with or without incidental dural tears. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE We analyzed 2,421 patients who underwent lumbar microendoscopic surgery and investigated patients with BBD after an incidental durotomy during surgery. OUTCOME MEASURES Patients were divided into three groups on the basis of dysuria and defecation disorders: severe BBD, mild BBD, and no BBD. The post void residual volumes before and after surgery were compared using an ultrasound bladder scanner or bladder catheterization after confirmation of urination. Bowel dysfunction was evaluated by subjective symptomatic deterioration and the increase in the frequency and duration of postoperative medical care. METHODS Risk factors for BBD were analyzed using surgical video documentation to determine the dural tear site and cauda equina exposure from the dural sac. Patients with BBD were prospectively followed up for prognosis determination. The chi-square test was used to compare the incidence of BBD between patients with dural tears and those without. Propensity score-adjusted logistic regression analysis was performed to evaluate the effects of various factors on the incidence of postoperative BBD. RESULTS The incidence of dural tears was 6.9% (168/2,421). The overall incidence of BBD was 3.0% (73/2,421), while the incidences of BBD (mild+severe BBD) and severe BBD due to incidental dural tears were 1.2% (30/2,421) and 0.8% (20/2,421), respectively. The incidence of BBD in patients with dural tears and those without tears was 17.9% [30/168] and 1.9% [43/2,253; p<.001]), respectively. BBD rates at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery were 64.0%, 44.0%, 40.0%, 28.0%, and 13.6%, respectively. Logistic regression analysis revealed that the male sex (odds ratio [OR], 4.20), dural tears in the central area (OR, 10.15), and exposure of the cauda equina (OR, 51.04) were significant risk factors. CONCLUSIONS The incidence of dural tears in lumbar microendoscopic surgeries are associated with an increased incidence of BBD. The recovery rate for BBD due to incidental dural tears is generally good; however, some patients experience long-term symptoms. Clinicians should be aware that incidental dural tears with cauda equina exposure can increase the risk of BBD.
Collapse
Affiliation(s)
- Masahito Oshina
- Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan.
| | - Tomohide Segawa
- Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan
| | - Nodoka Manabe
- Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Hirohiko Inanami
- Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo 140-0002, Japan
| |
Collapse
|
8
|
Agarwal P, Parihar V, Kukrele RR, Kumar A, Sharma D. Anatomical feasibility of anastomosing intercostal nerves (D10&D11) and subcostal nerve (D12) to S2 ventral root and lumbar plexus for management of bladder function after spinal cord injury. J Clin Orthop Trauma 2020; 11:900-904. [PMID: 32879578 PMCID: PMC7452297 DOI: 10.1016/j.jcot.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The transfer of peripheral nerves originating above the level of injured spinal cord into the nerves/roots below the injury is a promising approach. It facilitates the functional recovery in lower extremity, bladder/bowel and sexual function in paraplegics. We assessed anatomical feasibility of transfer of lower intercostal nerves to S2 ventral root in human cadaver for management of neurogenic bladder dysfunction in patients with spinal cord injury. METHODS Study was performed in five formalin fixed cadavers. Cadavers were placed in prone position. A transverse incision was made along 11th ribs on both sides and 10th, 11th Intercostal nerves (ICN) and subcostal nerve were harvested up to maximum possible length. In four cadavers the ventral root of S2 was exposed by endoscope and in one by the standard open laminectomy. Intercostal nerves were brought down to lumbo-sacral region, S2 ventral root was cut cranially and feasibility of intercostal to S2 anastomosis was assessed. RESULTS The mean length of intercostal nerves was 18.4 cm for the 10th 19.5 cm for the 11th and 22.15 cm for the subcostal nerve. The length of harvested nerve and the nerve length necessary to perform sacral roots neurotization were possible in all cases by only by subcostal nerve while T11 and T10 ICN fall short of the required length. CONCLUSION For Spinal cord lesions located at the conus, subcostal nerve could be connected to ventral root of S2 in an attempt to restore bladder function while 10th and 11th ICN had enough length to neurotize lumbar plexus.
Collapse
Affiliation(s)
- Pawan Agarwal
- NSCB Government Medical College, Jabalpur, MP, 482003, India,Corresponding author. 292/293, Napier Town, Jabalpur, 482001, MP, India.
| | - Vijay Parihar
- Department of Neurosurgery, Super Speciality Hospital, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Rajeev R. Kukrele
- Plastic Surgery Unit, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Ambuj Kumar
- NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| |
Collapse
|