Efficacy evaluation of personalized coaptation in neurotization for motor deficit after peripheral nerve injury: A systematic review and meta‐analysis

Abstract

Introduction: Peripheral neurotization, recently as a promising approach, has taken effect in recovering motor function after damage to a peripheral nerve root. Neural anastomosis comprised of nerve conduit and neurorrhaphy participates in the nerve reconstruction. Current literature lacks evidence supporting an individualized coaptation for rescue of locomotor loss in rat subjects with paraplegia secondary to peripheral nerve injury (PNI). Methods:This meta-analysis intends to qualify the specificity of gap-specific coaptation in treating a paralyzed limb following PNI. We used a highly sensitive search strategy to identify all published studies in multiple databases up to 1 May 2019. All identified trials were systematically evaluated using specific inclusion and exclusion criteria. Cochrane methodology was also applied to the results of this study.Results: Twelve studies, including 349 rat subjects, met eligibility criteria. For a medium nerve defect (0.5-3.0 cm), nerve conduit was more likely than neurorrhaphy to precipitate axon regeneration and improve motor outcome of the hemiplegic limb (OR = 3.61, 95% CI = 1.80, 7.26, p < .0003) at 3-month follow-up, whereas neurorrhaphy might take its place in promoting limb motor function in a small nerve gap (<0.5 cm) (OR = 0.48, 95% CI = 0.22, 1.07, p < .007). For a small nerve defect, nerve conduit still demonstrated visible effectiveness in recovery of limb motion albeit poorer than neurorrhaphy (OR = 1.50, 95% CI = 0.92, 2.47, p < .05). Conclusion: Selective neurotization facilitates motor regeneration after nerve transection, and advisable choice of neural coaptation can maximize functional outcome on an individual basis. K E Y W O R D S functional recovery, neurotization, neurotube, peripheral nerve injury, personalized coaptation

Neural tissue engineering: From bioactive scaffolds and in situ monitoring to regeneration

“…It is relatively easy to perform but can lead to misaligned bridging of the proximal and distal nerve stumps, resulting in poor or even failed repair. [ 2 ] When the gap is larger than 5 mm, a graft is necessary to bridge the two ends of the nerve stumps for restoring the nerve function. In this case, the “golden standard” in clinical treatment is autograft.…”

“…It is relatively easy to perform but can lead to misaligned bridging of the proximal and distal nerve stumps, resulting in poor or even failed repair. [2] When the gap is larger than 5 mm, a graft is necessary to bridge the two ends of the nerve stumps cellular components. In general, NGCs can be fabricated from natural or synthetic materials by different methods, such as casting, electrospinning, and 3D printing.…”

Unveiling adcyap1 as a protective factor linking pain and nerve regeneration through single-cell RNA sequencing of rat dorsal root ganglion neurons

“…However, due to the limited understanding of the mechanisms linking axonal regeneration and neuropathic pain after PNI, it remains unclear how to promote nerve regeneration while minimizing the risk of neuropathic pain during clinical treatment. Although nerve coaptation has been shown to prevent neuropathic pain by promoting nerve regeneration, it requires advanced surgical skills and is thus not widely applicable [ 40 , 41 ]. Additionally, in PNI studies, researchers typically examine axonal regeneration and neuropathic pain separately, and established animal models may not accurately represent PNI patients’ conditions.…”