Abstract
BackgroundPeripheral nerve (PN) transplantation and ventral root implantation are the two common types of recovery operations to restore the connection between motoneurons and their target muscles after brachial plexus injury. Despite experience accumulated over the past decade, fundamental knowledge is still lacking concerning the efficacy of the two microsurgical interventions.MethodsThirty-eight adult female Sprague–Dawley rats were divided into 5 groups. Immediately following root avulsion, animals in the first group (n = 8) and the second group (n = 8) received PN graft and ventral root implantation respectively. The third group (n = 8) and the fourth group (n = 8) received PN graft and ventral root implantation respectively at one week after root avulsion. The fifth group received root avulsion only as control (n = 6). The survival and axonal regeneration of severed motoneurons were investigated at 6 weeks post-implantation.ResultsRe-implantation of ventral roots, both immediately after root avulsion and in delay, significantly increased the survival and regeneration of motoneurons in the avulsed segment of the spinal cord as compared with PN graft transplantation.ConclusionsThe ventral root re-implantation is a better surgical repairing procedure than PN graft transplantation for brachial plexus injury because of its easier manipulation for re-implanting avulsed ventral roots to the preferred site, less possibility of causing additional damage and better effects on motoneuron survival and axonal regeneration.
Highlights
Peripheral nerve (PN) transplantation and ventral root implantation are the two common types of recovery operations to restore the connection between motoneurons and their target muscles after brachial plexus injury
Success of PN graft transplantation and ventral root implantation was confirmed by examining the integration of nerve with the host spinal cord during harvesting
All replanted PN grafts or ventral roots were found to be firmly connected with the spinal cord
Summary
Peripheral nerve (PN) transplantation and ventral root implantation are the two common types of recovery operations to restore the connection between motoneurons and their target muscles after brachial plexus injury. The insertion site had been optimized so as to minimize functional disorder of the spinal cord [13], implantation may inflict damage to a notyet traumatized area of the spinal cord These limitations may discourage the clinical application of PN transplantation in surgically treating brachial plexus injury. Surgical replantation of avulsed ventral roots was demonstrated to be effective in rescuing motoneurons, inducing axonal regeneration into the re-implanted ventral roots, and even promoting functional reinnervation of peripheral targets in various animal models [14,15,16,17,18,19] Most these implantation studies inserted the avulsed ventral rootlets into the parenchyma of the spinal cord to stimulate regeneration, which may cause additional damage to the spinal cord and require more challenging surgical skills
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