Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch.
Abbreviations used in this paper: CHEPS = contact heat evoked potentials stimulation; DRG = dorsal root ganglion; fMR = functional MR; H-reflex = Hoffman reflex; QST = quantitative sensory testing.
Address correspondence to: Thomas Carlstedt, M.D., Ph.D., The Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. email: firstname.lastname@example.org.
Please include this information when citing this paper: published online August 12, 2011; DOI: 10.3171/2011.7.JNS111106.
AthertonDDFacerPRobertsKMMisraVPChizhBABountraC: Use of the novel Contact Heat Evoked Potential Stimulator (CHEPS) for the assessment of small fibre neuropathy: correlations with skin flare responses and intraepidermal nerve fibre counts. BMC Neurol7:21–312007