Partial Return of Motor Function in Paralyzed Legs after Surgical Bypass of the Lesion Site by Nerve Autografts Three Years after Spinal Cord Injury

Abstract

Spinal cord injuries often result in irreversible loss of motor and somatosensory functions below the lesion level. Treatment is limited to physiotherapy aimed at compensating disability. We previously showed that re-establishment of tissue continuity can be achieved in animal models through nerve autografts implanted between the rostral spinal ventral horn and the caudal ventral roots. Rostral motor neuron axons could thus reach peripheral targets, leading to some return of motor function. We used a similar approach in a paraplegic patient with stabilized clinical states three years after spinal cord traumatic damage at the T9 level. Three segments from autologous sural nerves were implanted into the right and left antero-lateral quadrant of the cord at T7-8 levels, then connected to homolateral L2-4 lumbar ventral roots, respectively. Eight months after surgery, voluntary contractions of bilateral adductors and of the left quadriceps were observed. Muscular activity was confirmed by motor unit potentials in response to attempted muscle contraction. Motor-evoked potentials from these muscles were recorded by transcranial magnetic stimulation. These data support the hypothesis that muscles have been re-connected to supra-spinal centers through motor neurons located in the rostral stump of the damaged cord. They suggest that delayed surgical reconstruction of motor pathways may contribute to partial functional recovery.

The diameters and number of nerve fibers in spinal nerve roots

“…With the unceasing study of the regeneration capacity of the spinal nerve root axon, [8][9][10][11][12] spinal nerve root microanastomosis has been explored to recover the impaired nerve function in paraplegia patients. Furthermore, some researchers have partially restored muscle and pelvic organs function in paraplegia patients by various surgical procedures, [13][14][15] providing a new therapeutic approach for paraplegia. However, the optimum choice of donor nerve for anastomosis remains uncertain because of the lack of anatomical and histological data of related spinal nerve roots.…”

Peripheral Nerve Grafts and Chondroitinase ABC Application Improves Functional Recovery After Complete Spinal Cord Transection

“…This creates an anatomical gap that axons are unable to cross. There have been several approaches used to bridge this anatomical gap, including poly(lactide-co-glycolide) (PLGA) scaffolds [9,10], Schwann cells [11], poly(ethylene glycol) hydrogels [12,13], agarose scaffolds [14,15], and peripheral nerve grafts (PNGs) [16][17][18][19][20][21][22]. PNGs are a living tissue containing several growth factors that have been shown to promote axonal growth, and cytokines that modulate inflammation [23,24].…”

The Application of Stem Cell Based Tissue Engineering in Spinal Cord Injury Repair.

“…After surgery, both motor and sensory functions were improved on all patients. Compared to the reported surgery only cases [71], these 14 patients were better recovered on the point of muscular activities although they were still unable to stand erect and hold their knees extended while walking unaided. Seroma would be a complication related to chitosan disintegration [72].…”