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Thomas Carlstedt – One of the best experts on this subject based on the ideXlab platform.
long term outcome of brachial plexus reimplantation after complete brachial plexus Avulsion InjuryWorld Neurosurgery, 2017Co-Authors: Carolina Kachramanoglou, Thomas Carlstedt, M Koltzenburg, David ChoiAbstract:
Background Complete brachial plexus Avulsion Injury is a severe disabling Injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus Avulsion Injury. Objective We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus Avulsion Injury with clinical examination and electrophysiological testing. Methods We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. Results We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome. Conclusions Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus Injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.
new treatments for spinal nerve root Avulsion InjuryFrontiers in Neurology, 2016Co-Authors: Thomas CarlstedtAbstract:
Further progress in the treatment of the longitudinal spinal cord Injury has been made. In an inverted translational study it has been demonstrated that return of sensory function ca be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root Avulsion Injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organisation of glia reaction to Injury was demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root Avulsion as well as spinal cord injuries.
Segmental Spinal Root Avulsion in the Adult Rat: A Model To Study Avulsion Injury PainJournal of Neurotrauma, 2013Co-Authors: Daniel J. Chew, Karen Murrell, Thomas Carlstedt, Peter J. ShortlandAbstract:
Abstract Road traffic accidents are the most common cause of Avulsion Injury, in which spinal roots are torn from the spinal cord. Patients suffer from a loss of sensorimotor function, intractable spontaneous pain, and border-zone hypersensitivity. The neuropathic pains are particularly difficult to treat because the lack of a well-established animal model of Avulsion Injury prevents identifying the underlying mechanisms and hinders the development of efficacious drugs. This article describes a hindlimb model of Avulsion Injury in adult rats where the L5 dorsal and ventral spinal root are unilaterally avulsed (spinal root Avulsion [SRA]), leaving the adjacent L4 spinal root intact. SRA produced a significant ipsilateral hypersensitivity to mechanical and thermal stimulation by 5 days compared with sham-operated or naive rats. This hypersensitivity is maintained for up to 60 days. No autotomy was observed and locomotor deficits were minimal. The hypersensitivity to peripheral stimuli could be temporarily a…
Yoshitomo Uchiyama – One of the best experts on this subject based on the ideXlab platform.
spinal cord herniation into associated pseudomeningocele after brachial plexus Avulsion Injury case reportNeurosurgery, 2007Co-Authors: Hiroshi Yokota, Kazuhiro Yokoyama, Hiroshi Noguchi, Yoshitomo UchiyamaAbstract:
OBJECTIVE: Posttraumatic spinal cord herniation is a rare condition. We describe a case of spinal cord herniation into an associated pseudomeningocele after a brachial plexus Avulsion Injury. CLINICAL PRESENTATION: A 33-year-old man began to develop progressive Homer’s syndrome 14 years after a brachial plexus Avulsion Injury. At a clinical presentation 17 years after that Injury, sensory disturbance and a unilateral pyramidal sign were also evident. In addition to myelography and computed tomographic myelography findings, coronal magnetic resonance imaging scans clearly demonstrated herniation of the spinal cord into a large pseudomeningocele inside the C7-T1 intervertebral foramen. Another pseudomeningocele inside the T1-T2 intervertebral foramen was also noted. INTERVENTION: The patient underwent a C6-T2 laminectomy, during which the spinal cord was found to be herniated through a dural defect into a pseudomeningocele at the C8 root level, and a second dural defect was also shown, with an arachnoid outpouching that included an avulsed T1 root. The spinal cord herniation was reduced and the dural defects were repaired. After surgery, the patient showed no significant neurological changes, and his condition stabilized. CONCLUSION: Brachial plexus root Avulsions may result in the formation of pseudomeningoceles and can lead to spinal cord herniation. Coronal magnetic resonance imaging is useful to demonstrate spinal cord herniation as well as pseudomeningoceles. Surgical treatment is recommended for such cases with progressive symptoms to prevent further deterioration.
P Anand – One of the best experts on this subject based on the ideXlab platform.
return of spinal reflex after spinal cord surgery for brachial plexus Avulsion InjuryJournal of Neurosurgery, 2012Co-Authors: Thomas Carlstedt, Peter V Misra, Anastasia Papadaki, Donald Mcrobbie, P AnandAbstract:
Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus Avulsion Injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors’ knowledge, this case represents the first time that spinal cord surgery could restore not only motor …
co treatment with riluzole and gdnf is necessary for functional recovery after ventral root Avulsion InjuryExperimental Neurology, 2004Co-Authors: Astrid Bergerot, Peter J. Shortland, P Anand, Stephen P Hunt, Thomas CarlstedtAbstract:
Unilateral Avulsion of lumbar ventral roots kills approximately 50% of injured motoneurons within 2 weeks of surgery. Immediate treatment involving surgical reimplantation of the ventral root (VRI) or intrathecal glial cell line-derived neurotrophic factor (GDNF) delivery or intraperitoneal injection of riluzole for 2 weeks ameliorates motoneuron death to 80% of control but combining the different treatment paradigms did not further enhance survival except when GDNF was combined with VRI. At 3 months, all combined treatments provided a neuroprotective effect compared to Avulsion only, but the neuroprotective effect of surgical reimplantation alone was not maintained unless combined with riluzole and GDNF treatment. Analysis of regenerating motoneurons using retrograde labelling techniques showed that riluzole, but not GDNF, increased the number of dendrites per labelled motoneuron. However, when functional motor recovery was assessed using the BBB locomotor score and rotarod tests, only VRI animals treated with riluzole and GDNF application showed significantly improved locomotor function in both tests. Our results show that functional recovery appears related to a combination of enhanced dendrite formation, increased motoneuron survival and the neurotrophic actions of GDNF. Thus, combination treatment may offer a new therapeutic strategy for treating patients with Avulsion Injury.
restoration of hand function and so called breathing arm after intraspinal repair of c5 t1 brachial plexus Avulsion Injury case reportNeurosurgical Focus, 2004Co-Authors: T Carlstedt, P Anand, Min Htut, Peter Misra, Mikael SvenssonAbstract:
This 9-year-old boy sustained a complete right-sided C5–T1 brachial plexus Avulsion Injury in a motorcycle accident. He underwent surgery 4 weeks after the accident. The motor-related nerve roots in all parts of the avulsed brachial plexus were reconnected to the spinal cord by reimplantation of peripheral nerve grafts. Recovery in the proximal part of the arm started 8 to 10 months later. Motor function was restored throughout the arm and also in the intrinsic muscles of the hand by 2 years postoperatively. The initial severe excruciating pain, typical after nerve root Avulsions, disappeared completely with motor recovery. The authors observed good recruitment of regenerated motor units in all parts of the arm, but there were cocontractions. Transcranial magnetic stimulation produced response in all muscles, with prolonged latency and smaller amplitude compared with the intact side. There was inspiration-evoked muscle activity in proximal arm muscles—that is, the so-called “breathing arm” phenomenon. The issues of nerve regeneration after intraspinal reimplantation in a young individual, as well as plasticity and associated pain, are discussed. To the best of the authors’ knowledge, the present case demonstrates, for the first time, that spinal cord surgery can restore hand function after a complete brachial plexus Avulsion Injury.