Direct Spinal Ventral Root Repair following Avulsion: Effectiveness of a New Heterologous Fibrin Sealant on Motoneuron Survival and Regeneration.

Mateus Vidigal De Castro,Roberta Barbizan,Benedito Barraviera,Alexandre Leite Rodrigues De Oliveira,Rui Seabra Ferreira

doi:10.1155/2016/2932784

Abstract

Axonal injuries at the interface between central and peripheral nervous system, such as ventral root avulsion (VRA), induce important degenerative processes, mostly resulting in neuronal and motor function loss. In the present work, we have compared two different fibrin sealants, one derived from human blood and another derived from animal blood and Crotalus durissus terrificus venom, as a promising treatment for this type of injury. Lewis rats were submitted to VRA (L4–L6) and had the avulsed roots reimplanted to the surface of the spinal cord, with the aid of fibrin sealant. The spinal cords were processed to evaluate neuronal survival, synaptic stability, and glial reactivity, 4 and 12 weeks after lesion. Sciatic nerves were processed to investigate Schwann cell activity by p75NTR expression (4 weeks after surgery) and to count myelinated axons and morphometric evaluation (12 weeks after surgery). Walking track test was used to evaluate gait recovery, up to 12 weeks. The results indicate that both fibrin sealants are similarly efficient. However, the snake-derived fibrin glue is a potentially safer alternative for being a biological and biodegradable product which does not contain human blood derivatives. Therefore, the venom glue can be a useful tool for the scientific community due to its advantages and variety of applications.

Highlights

Spinal roots injuries constitute an important medical problem and usually affect the brachial plexus in consequence of high energy trauma, causing motor, sensibility, and autonomic loss [1,2,3,4,5]
The brachial plexus injury is extremely debilitating for the patient because, besides significant upper limb function loss, it causes an everyday tasks limitation [6], which can result in unemployment, depression, and in some cases even suicide [6]
Neuronal survival after ventral root avulsion (VRA) and reimplantation was evaluated by the counting of motoneurons present at lamina IX of the ventral horn, in the ipsilateral side as compared to contralateral side, 4 and 12 weeks after lesion (Figure 1)

Summary

Introduction

Spinal roots injuries constitute an important medical problem and usually affect the brachial plexus in consequence of high energy trauma, causing motor, sensibility, and autonomic loss [1,2,3,4,5]. The brachial plexus injury is extremely debilitating for the patient because, besides significant upper limb function loss, it causes an everyday tasks limitation [6], which can result in unemployment, depression, and in some cases even suicide [6]. Such medical problem is typically associated with young patients following motorcycle and radical sports accidents [1]. Astroglial and microglial reactivity [16], together with the presence of meningeal fibroblasts [17], contribute to the formation of the so-called glial scar, minimizing chances of target organ reinnervation, culminating with an irreversible state of paralysis [15]

Methods

Results

Conclusion