New Treatments for Spinal Nerve Root Avulsion Injury

Abstract

Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries.

New Aspects of Graft-induced Central Plasticity and Neuroregeneration at T 10 in a Rat Model†

“…Regarding the small number of animals assessed, this effect was coincidental with the positive electrical stimulation. This observation could be interpreted in accordance with reports showing the influence of CERE on the biochemical mechanism of neuroprotection and neuro-recovery [1,8,18,[82][83][84][85][86][87][88][89][90]. We recommend a new study examining the neuroprotective effect of CERE medication in our grafting procedure model with more extensive CERE treatment up to four weeks and a longer follow up of 6 months, which might provide more detailed insight into its beneficial neuromodulation potency on central plasticity.…”

“…Neuroplasticity can be defined as the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections. Major advances in our understanding of neuroplasticity have, to date, yielded few established interventions [4][5][6]42,[55][56][57][58]77,78,[80][81][82][83][84][85][86], Brunelli decided on a total neurotransmitter switch at the neuromuscular junction from cholinergic to glutamatergic [11,[71][72][73]. In contrast to the GB group, we did not observe any FB+ neurons in the brain, but we did observe them in many laminae of the SC gray matter.…”

“…Until now, traumatic paraplegia by severance of the spinal cord (SC) remains an irreversible condition. Basically, current clinical treatment strategies are targeted to promote axon regeneration and outgrowth beyond the scar formation following SC avulsion [1][2][3][4][5][8][9][10][11][12][13][14][15][16][17][18][20][21][24][25][26][27][28][29][30][31][72][73][74][75][76][77][78][79][80][81][82][83][84][85] Previous experimental and clinical studies together with GB have aroused some hope that paraplegic patients might achieve some selective voluntary muscle reinnervation after grafting the first motor neuron to skeletal hip muscles [10,11,25,72,73].…”

Nerve Root Reimplantation in Brachial Plexus Injuries

“…The long distance to cover is a big impediment to a successful functional recovery [72,73]. By the time the muscles get reinnervated, they are atrophic and with fibrotic changes, particularly the most distal ones [74]. The regeneration is not privative to the axon, and the dendrites can also regenerate as axon, creating what has been called a dendraxon.…”

“…The misrouting is responsible for simultaneous contractures in agonist and antagonist muscles leading to ineffective limb movements [30]. Fourth, there is severe muscular atrophy due to lack of use [74]. Hence, for a successful clinical result, MN survival must be improved, axonal regeneration has to be enhanced and accelerated, misrouting should be minimized and muscle atrophy should be prevented [15,72].…”