Neurogenic bladder dysfunction following spinal cord injury is a major medical and social problem for which there is no ideal treatment strategy. This paper describes the authors' attempts to establish bladder reinnervation, by establishing an abdomen-to-bladder reflex pathway, in a patient with an injury to the conus medullaris.
Haodong Lin, Chunlin Hou and Aimin Chen
Haodong Lin, Aimin Chen and Chunlin Hou
Nerve transfer is used for brachial plexus injuries but has rarely been applied to repairs in the lower extremities. The aim of this study was to evaluate the feasibility and effectiveness of using the contralateral L-6 nerve root to repair lumbosacral plexus root avulsions.
Eighteen rhesus monkeys were randomized into 3 groups. In the experimental group, the left L4–7 and S-1 nerve roots were avulsed and the right L-6 nerve root was transferred to the left inferior gluteal nerve and the sciatic nerve branch innervating the hamstrings. In the control group, the left L4–7 and S-1 nerve roots were avulsed and nerve transfer was not performed. In the sham operation group, the animals underwent a procedure that did not involve nerve avulsion and nerve transfer. Functional outcomes were measured by electrophysiological study, muscle mass investigation, and histological study.
The mean amplitudes of the compound muscle action potentials from the gluteus maximus and biceps femoris in the experimental group were higher than those in the control group but lower than those in the sham group (p < 0.05). The muscle mass and myofiber cross-sectional area of these muscles were heavier and larger than those in the control group (p < 0.05). The number of myelinated nerve fibers of the inferior gluteal nerve and the branch of the sciatic nerve innervating the hamstrings in the control group was significantly smaller than the number in the experimental and sham groups (p < 0.01).
In this animal model, the contralateral L-6 (analogous to S-1 in humans) nerve root can be used to repair lumbosacral plexus root avulsion.
Haodong Lin, Chunlin Hou, Aimin Chen and Zhen Xu
Hand function is severely impaired in cases of lower root avulsion. In the present study, the authors investigated the clinical effectiveness and safety of phrenic nerve transfer to the posterior division of the lower trunk of the brachial plexus to recover thumb and finger extension.
Between 2004 and 2006, 10 patients with brachial plexus palsy underwent phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age of was 27.2 years (range 18–44 years), and the mean interval from injury to surgery was 5.7 months (range 3–9 months). The phrenic nerve was always transferred to the posterior division of the lower trunk.
The follow-up of the patients ranged from 2.5 to 4.4 years, with an average follow-up length of 3.5 years. There were no major complications related to the surgery. Eight patients recovered to Grade 3 or better (Medical Research Council grade) in extensor digitorum strength, and 7 patients recovered to Grade 3 or better in extensor pollicis strength. None of the patients had any clinical signs or symptoms of respiratory insufficiency.
Satisfactory thumb and finger extension can be achieved by phrenic nerve transfer to the posterior division of the lower trunk of the brachial plexus. This procedure is simple and less traumatic than that of transferring the phrenic nerve to the radial nerve. It is indicated in cases in which the brachial plexus is relatively intact at the division level.