Intercostal-lumbar-spinal nerve anastomoses for cord transection: A preliminary investigation

Dai, Kefang

doi:10.1097/00006534-198605000-00076

Cited by 5 publications

(5 citation statements)

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“…Application of peripheral nerve transfers for SCI is not new. 3 , 4,11,26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Most clinical applications have utilized intercostal nerve roots proximal to the SCI to reinnervate lumbar plexus nerve. The nerve transfer strategies for the treatment of cervical SCI are relatively sparse, especially for restoration of hand function.…”

Section: Discussionmentioning

confidence: 99%

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Hawasli

Chang

Reynolds

et al. 2014

Global Spine Journal

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Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

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Section: Discussionmentioning

confidence: 99%

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Hawasli

Chang

Reynolds

et al. 2014

Global Spine Journal

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“…In recent decades, some scholars have partially reconstructed variable nerve function under the level of SCI by different methods of neuroanastomosis, which provides a new approach for the treatment of paraplegia. [3][4][5][6] In order to improve the therapeutic effect, the anatomical and histological features of spinal nerve roots have important clinical significance. In this study, we investigate the microstructure, diameter, and nerve fiber quantity of spinal nerve roots from C1 to S5 to provide fundamental data for spinal nerve root microanastomosis treatment.…”

Section: Introductionmentioning

confidence: 99%

The diameters and number of nerve fibers in spinal nerve roots

Liu

Zhou

et al. 2014

The Journal of Spinal Cord Medicine

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Objective: To investigate the anatomical and histological features of spinal nerve roots and provide base data for neuroanastomosis therapy for paraplegia. Methods: Spinal nerve roots from C1 to S5 were exposed on six adult cadavers. The diameter and the number of nerve fibers of each nerve root were measured, respectively, with a caliper and image analysis software. Results: As for ventral roots, the diameter of C5 (2.50 ± 0.55 mm) was the largest in cervical segments. In thoracic and lumbosacral segments, the diameter gradually increased from T11 to S1 and then decreased from S1 to S5 except L3. S1 (1.43 ± 0.16 mm) was the thickest root and S5 (0.14 ± 0.02 mm) was the thinnest one. As for dorsal roots, the diameter of C7 (4.61 ± 0.87 mm) was the largest in cervical segments. From T11 to S1, the diameter increased and then decreased gradually from S1 to S5. The diameter of dorsal roots from T1 to S5 was largest at S1 (2.95 ± 0.57 mm) and smallest at S5 (0.27 ± 0.13 mm), respectively. C7 (8467 ± 1019), T12 (6538 ± 892), L3 (9169 ± 1160), and S1 (8253 ± 1419) ventral roots contained the most nerve fibers in cervical, thoracic, lumbar, and sacral segments, respectively. Similarly, C7 (39 653 ± 8458), T1 (26 507 ± 7617), L5 (34 455 ± 2740), and S1 (41 543 ± 3036) dorsal roots, respectively, contained the most nerve fibers in their corresponding segments. Conclusion:The findings in the current study provided the imperative data and may be valuable for spinal nerve root microanastomosis surgery in the paraplegic patients.

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“…8,13,25 Moderate recovery of lower limb motor function (Medical Research Council [MRC] grades 1-3) was reported in 5 of 21 patients following intercostal transfer to lumbosacral nerve roots. 10 In one promising clinical series, 18 of 23 patients were reported to have regained the ability to step forward and were eventually able to walk with an ambula- tory assistive device following transfer of 2 or 4 intercostal nerves to various lumbar nerve roots. 39 General anesthesia was induced using various agents such as enflurane, halothane, neuroleptics, nitrous oxide, and propofol.…”

Section: Discussionmentioning

confidence: 99%

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

Toreih¹,

Sallam²,

Ibrahim

et al. 2019

Journal of Neurosurgery: Spine

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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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Intercostal-lumbar-spinal nerve anastomoses for cord transection: A preliminary investigation

Cited by 5 publications

References 0 publications

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

The diameters and number of nerve fibers in spinal nerve roots

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

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