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  • Author or Editor: Jayme Augusto Bertelli x
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Brachial plexus repair by peripheral nerve grafts directly into the spinal cord in rats

Behavioral and anatomical evidence of functional recovery

Jayme Augusto Bertelli and Jean Claude Mira

✓ Over the years, peripheral nerve grafts, a favorable environment for the support of axonal elongation, have attracted interest as a possible means of promoting spinal cord repair. In the experiments described here, rats underwent an avulsion injury of the brachial plexus, and the musculocutaneous nerve was repaired by direct insertion of peripheral nerve grafts into the spinal cord. After varying postoperative periods, the rats were submitted to a series of behavioral tests to evaluate forelimb and hindlimb function. They also underwent retrograde double-labeling studies. Nerve grafts were harvested and processed for electronic microscopy. The biceps muscle was removed and weighed and its histology studied.

After surgery, central axons effectively regenerated about 65 mm along the peripheral nerve grafts, restoring normal active elbow flexion. Forelimb movements were well coordinated in both voluntary and automatic activities. Clinical investigations showed that there were no side effects in the ipsilateral forepaw, contralateral forelimb, or either hindlimb. Regenerating axons stemmed from original motoneurons, foreign motoneurons, and even antagonist motoneurons, but this did not impair function. Ganglionic neurons from adjacent roots also sent processes to the peripheral nerve grafts.

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Jayme Augusto Bertelli, Jean Claude Mira, Monique Pecot-Dechavassine and Alain Sebille

✓ Misdirection of sensory fibers into motor pathways is, in part, responsible for the poor results obtained after peripheral nerve repair. After avulsion of the C-5 root in rats, the authors connected a C-4 ventral rootlet to the musculocutaneous nerve by means of a sural nerve graft. In this way, they were able to increase the number of regenerating motor fibers and avoid growth of sensory fibers into the nerve grafts. Functional recovery was evaluated electrophysiologically and histologically. The origin of the axons that reinnervated the nerve graft was analyzed by means of morphological studies including retrograde labeling procedures. Motor neurons survived and regenerated after the rootlet transfer and there was no functional impairment. Many neurons were retrograde labeled in the ventral horn and widespread biceps muscle reinnervation was demonstrated with recovery of nearly normal electrophysiological properties. Motor hyperreinnervation of the musculocutaneous nerve was observed. This high degree of reinnervation in a long (40-mm) graft was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from reinnervation.