Spinal root avulsion: an excellent model for studying motoneuron degeneration and regeneration after severe axonal injury

Ruven, Carolin; Chan, T. W. Y.; Wu, Wutian

doi:10.4103/1673-5374.125338

Cited by 15 publications

(7 citation statements)

References 34 publications

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“…Second, muscles are fibrotic by the time the regenerating axonal sprouts reach the motor end plates [72,73]. In rats, functional recovery is seen only in cervical but not in lumbosacral avulsion models as the distance to cover is much shorter for the cervical NRs [9,40,[85][86][87], and in any case only proximal limb muscle recovery is seen [86][87][88][89]. Third, the regenerating fibers may reach the wrong target due to misrouting [53], and in the absence of NG or conduit, the regenerating axons will grow along the surface of the SC [27,43,53,83,87].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Soon after avulsion anterior horn motor neurons (MN) and sensory neurons at the dorsal root ganglion (DRG) undergo apoptosis [8][9][10][11][12][13][14][15][16][17]. Inside the avulsed NR itself, there is a Wallerian degeneration with axonal and myelin loss [18].…”

Section: Introductionmentioning

confidence: 99%

“…After complete NRA, spontaneous regeneration is impossible [9]. In case of a single NRA, recovery coming from nearby healthy ones can be expected in neonates but not in adult patients [25].…”

Section: Introductionmentioning

confidence: 99%

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Nerve Root Reimplantation in Brachial Plexus Injuries

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Nerve root avulsion is the most severe form of brachial or lumbosacral plexus injury. Spontaneous recovery is extremely rare, and when all the nerve roots of the affected plexus are avulsed, the therapeutic options are very limited. Nerve root reimplantation has been attempted since the 1990s, first in experimental animal models and afterwards in human beings. Currently, only partial recovery of the proximal limb muscles has been achieved. New therapeutic strategies have been developed to improve motor neuron survival and axonal regeneration, with promising results. Neurotrophic factors and some drugs have been used successfully to improve the regenerating ability, but long-term studies in humans are needed to develop complete recovery of the affected limb.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nerve Root Reimplantation in Brachial Plexus Injuries

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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“…1 ; red arrow) nerve injuries which is of paramount importance because their reconstruction and prognosis is different. Post-ganglionic nerve injuries (ruptures or attenuations) have a more favourable prognosis because the anterior horn cells in the spinal cord persist [ 20 , 21 ]; therefore, if continuity can be re-established in a timely fashion, then motor recovery can be expected [ 22 – 30 ]. Conversely, reconstructing pre-ganglionic nerve injuries (known as root avulsions) requires nerve transfers as the cell bodies of the native motor neurones recede [ 5 , 6 , 13 , 20 ] and re-implantation of roots remains of uncertain value [ 31 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy

Wade¹,

Takwoingi²,

Wormald³

et al. 2018

Syst Rev

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BackgroundAdult brachial plexus injuries (BPI) are becoming more common. The reconstruction and prognosis of pre-ganglionic injuries (root avulsions) are different to other types of BPI injury. Preoperative magnetic resonance imaging (MRI) is being used to identify root avulsions, but the evidence from studies of its diagnostic accuracy are conflicting. Therefore, a systematic review is needed to address uncertainty about the accuracy of MRI and to guide future research.MethodsWe will conduct a systematic search of electronic databases alongside reference tracking. We will include studies of adults with traumatic BPI which report the accuracy of preoperative MRI (index test) against surgical exploration of the roots of the brachial plexus (reference standard) for detecting either of the two target conditions (any root avulsion or any pseudomeningocoele as a surrogate marker of root avulsion). We will exclude case reports, articles considering bilateral injuries and studies where the number of true positives, false positives, false negatives and true negatives cannot be derived. The methodological quality of the included studies will be assessed using a tailored version of the QUADAS-2 tool. Where possible, a bivariate model will be used for meta-analysis to obtain summary sensitivities and specificities for both target conditions. We will investigate heterogeneity in the performance of MRI according to field strength and the risk of bias if data permits.DiscussionThis review will summarise the current diagnostic accuracy of MRI for adult BPI, identify shortcomings and gaps in the literature and so help to guide future research.Systematic review registrationPROSPERO CRD42016049702.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0737-2) contains supplementary material, which is available to authorized users.

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“…Preganglionic avulsion injury is a severe form of preganglionic nerve injury that causes a disconnection between the central and peripheral nervous systems. Avulsion injury, considered the most severe type of preganglionic injury, is associated with a marked and progressive death of motoneurons [4, 5] with a very poor prognosis for functional recovery. Currently, there is no generally approved, efficient treatment for the avulsion injury.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of Pre- and Postganglionic Nerve Injury Using MRI of the Spinal Cord

et al. 2016

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Brachial plexus injury (BPI) is a devastating type of nerve injury, potentially causing loss of motor and sensory function. Principally, BPI is either categorized as preganglionic or postganglionic, with the early establishment of injury level being crucial for choosing the correct treatment strategy. Despite diagnostic advances, the need for a reliable, non-invasive method for establishing the injury level remains. We studied the usefulness of in vivo magnetic resonance imaging (MRI) of the spinal cord for determination of injury level. The findings were related to neuronal and glial changes. Rats underwent unilateral L4 & L5 ventral roots avulsion or sciatic nerve axotomy. The injuries served as models for pre- and postganglionic BPI, respectively. MRI of the L4/L5 spinal cord segments 4 weeks after avulsion showed ventral horn (VH) shrinkage on the injured side compared to the uninjured side. Axotomy induced no change in the VH size on MRI. Following avulsion, histological sections of L4/L5 revealed shrinkage in the VH grey matter area occupied by NeuN-positive neurons, loss of microtubular-associated protein-2 positive dendritic branches (MAP2), pan-neurofilament positive axons (PanNF), synaptophysin-positive synapses (SYN) and increase in immunoreactivity for the microglial OX42 and astroglial GFAP markers. Axotomy induced no changes in NeuN-reactivity, modest decrease of MAP2 immunoreactivity, no changes in SYN and PanNF labelling, and a modest increase in OX42 and SYN labeling. Histological and radiological findings were congruent when assessing changes after axotomy, while MRI somewhat underestimated the shrinkage. This study indicates a potential diagnostic value of structural spinal cord MRI following BPI.

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Spinal root avulsion: an excellent model for studying motoneuron degeneration and regeneration after severe axonal injury

Cited by 15 publications

References 34 publications

Nerve Root Reimplantation in Brachial Plexus Injuries

Nerve Root Reimplantation in Brachial Plexus Injuries

Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy

Differentiation of Pre- and Postganglionic Nerve Injury Using MRI of the Spinal Cord

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