Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study

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OBJECTIVE

Spinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.

METHODS

The feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.

RESULTS

The donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.

CONCLUSIONS

Intercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

ABBREVIATIONS ASIS = anterosuperior iliac spine; EMG = electromyography; MAP = motor action potential; NT = nerve transfer; SCI = spinal cord injury.

Article Information

Correspondence Asser A. Sallam: Suez Canal University Hospitals, Ismailia, Egypt. assersallam@hotmail.com.

INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.8.SPINE181.

A.A.T. and A.A.S. contributed equally to this article.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustrations depicting the surgical incisions used in the cadaver study. Left: The ilioinguinal incision for ilioinguinal and iliohypogastric to femoral nerve bypass surgery. Right: The surgical incisions and the subcutaneous tunnel for intercostal to gluteal nerve bypass surgery.

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    Transfer of the ilioinguinal and iliohypogastric to the femoral nerve in a dog. A: The incision was made just distal to the inguinal ligament. B: Identification of ilioinguinal (II), iliohypogastric (IH), and femoral (F) nerves. C: The ilioinguinal and iliohypogastric nerves were divided as distally as possible and transferred to the femoral nerve, which was divided as proximally as possible to allow for a tension-free repair. D: The completed anastomosis.

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    Intercostal nerve transfer to the gluteal nerves in a dog. The dog was placed in a lateral position. A: The lateral thoracic incision and another 2 transgluteal incisions for superior gluteal nerve (SGN) and inferior gluteal nerve (IGN). B: Exploration of 10th (T-10), 11th (T-11), and 12th (T-12) intercostal nerves, and the subcostal nerve (T-13) C: Identification of SGN. D: Identification of IGN. E: The completed anastomosis after transfer of T-10 and T-11 to the SGN. F: The completed anastomosis after transfer of the 12th and 13th intercostal nerves to the IGN.

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    Mean thigh circumference before and after surgery in NT and control groups. The y-axis shows thigh circumference in centimeters.

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    The amplitude of the MAPs in the study and control groups at baseline and the 6-week, 12-week, and 6-month follow-up assessments of the femoral nerve (left) and gluteal nerves (right).

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