Spinal cord surgery after root avulsion injury in man results in motor and sensory recovery

Abstract

Event Abstract Back to Event Spinal cord surgery after root avulsion injury in man results in motor and sensory recovery Thomas Carlstedt1* 1 Karolinska Institutet, Hand surgery, Sweden Spinal nerve root avulsion is a longitudinal spinal cord injury that affects mainly the final common motor pathway and the primary sensory medullary trajectories. In humans this occurs most frequently in traction injuries to the brachial plexus but also in trauma to the lumbosacral plexus and cauda equina as well as conus medullaris. This injury has serious effects on the pertinent spinal cord segment with the breakdown of connections and networks, death of motor, autonomic and sensory neurons and the development of a spinal cord scar. This injury often occurs as a result of road traffic accidents or violent acts. About 1000 patients are affected annually in the UK. The functional consequence of such injury is lower motoneuron syndromes, associated with autonomic paralysis including dysfunctional internal organs, limb muscle atrophy, sensory impairment and chronic pain. Spinal nerve root injury has been associated with an overall poor clinical outcome as a successful surgical repair would require axonal regrowth within the central nervous system as spinal cord regeneration. A surgical technique for the repair of this spinal cord injury was developed from basic science experiments and successfully translated to humans. Today, the reimplantation of avulsed ventral roots to the spinal cord in total brachial plexus avulsion injury restores useful proximal limb function and is the method of choice in the treatment of such devastating injuries. Even hand function can be restored by this technique. By means of functional magnetic resonance imaging (fMRI) it was established that the restored hand function relayed on pre-injury established cortical sensory program. Sensory roots are not possible to replant with functional recovery. Sensory recovery is therefore not occurring. In some cases as an expression of plasticity there are phenomenona observed as referrals of sensation to the denervated limb as well as hypersensitivity at border zones between normal and denervated dermatomes. When nerve graft has been implanted into the dorsal part of the spinal cord it has been possible to record return of some aspects of sensation. There was in such a case possible to elicit a biceps reflex and also record by means of electrophysiology a H-reflex proving that by this surgical technique it has been possible to restore a sensory-motor spinal cord reflex. However, neither quantitative sensory testing (QST), nor contact heat evoked potential stimulation (CHEPs) could demonstrate any exteroceptive sensory qualities. Pain, which is most severe and excruciating in most cases of brachial plexus avulsion injuries were found to be alleviated in conjunction with motor recovery after motor (but not sensory) root replantation. The mechanisms behind this are elusive but recent observations have indicated that there is retrograde transneuronal degeneration into the spinal cord dorsal horn following ventral root avulsion. This is reversed by ventral root replantation. These observation achieved by spinal cord surgery will serve as baseline data when assessing the effects of future application of adjuvant therapies Keywords: avulsion, Pain, Regeneration, Spinal Cord, spinal nerve root Conference: Karolinska Institutet 200 years anniversary Symposium on Traumatic Injuries in the Nervous System, Stockholm, Sweden, 15 Sep - 16 Sep, 2010. Presentation Type: Presentation Topic: Traumatic Injuries in the Nervous System Citation: Carlstedt T (2010). Spinal cord surgery after root avulsion injury in man results in motor and sensory recovery. Front. Neurol. Conference Abstract: Karolinska Institutet 200 years anniversary Symposium on Traumatic Injuries in the Nervous System. doi: 10.3389/conf.fneur.2010.56.00020 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 03 Sep 2010; Published Online: 21 Sep 2010. * Correspondence: Prof. Thomas Carlstedt, Karolinska Institutet, Hand surgery, Stockholm, Sweden, carlstedt.thomas@googlemail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Thomas Carlstedt Google Thomas Carlstedt Google Scholar Thomas Carlstedt PubMed Thomas Carlstedt Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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