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Thomas Carlstedt - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of brachial plexus reimplantation after complete brachial plexus Avulsion Injury
World 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.
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new treatments for spinal nerve root Avulsion Injury
Frontiers 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.
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Segmental Spinal Root Avulsion in the Adult Rat: A Model To Study Avulsion Injury Pain
Journal 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...
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return of spinal reflex after spinal cord surgery for brachial plexus Avulsion Injury
Journal 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 ...
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a comparative histological analysis of two models of nerve root Avulsion Injury in the adult rat
Neuropathology and Applied Neurobiology, 2011Co-Authors: Daniel J. Chew, Thomas Carlstedt, Peter J. ShortlandAbstract:Aims: This study has investigated the reliability of the artificial surgical model dorsal root rhizotomy (DRR), to the surgical tearing of the roots, Avulsion, that occurs clinically. Root Avulsion of the limb nerves is common in high-impact motor vehicle accidents and results in paraesthesia, paralysis and intractable pain. Limited treatment options are largely due to a lack of basic research on underlying mechanisms, and few animal models. We assess this limitation by histologically assessing the spatial and temporal Injury profile of dorsal root Avulsion (DRA) and DRR within the spinal cord.Methods: Rats underwent DRR, DRA or sham surgery to the L3–L6 dorsal roots unilaterally. At 1, 2, 14, and 28 days post Injury, immunohistochemical density staining was used to characterize the progression of spinal cord trauma. Neuronal (NeuN) and vascular degeneration (RECA-1), inflammatory infiltrate (ED1, anti-neutrophil), gliosis (Iba1, GFAP) and apoptosis (TUNEL) were assessed. Results: Unilateral DRA produced a prolonged and bilateral glial and inflammatory response, and vascular degeneration compared to transient and unilateral effects after DRR. Transsynaptic neurodegeneration after DRA was greater than after DRR, and progressed across 28 days coinciding with gliosis and macrophage infiltration. Conclusions: Rhizotomy leads to a milder representation of the spinal cord trauma that occurs after ‘true’ Avulsion Injury. We recommend DRA be used in the future to more reliably model clinical Avulsion Injury. Avulsion is an Injury with a chronic profile of degenerative and inflammatory progression, and this theoretically provides a window of clinical therapeutic opportunity in treatment of secondary trauma progression.
Yoshitomo Uchiyama - One of the best experts on this subject based on the ideXlab platform.
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spinal cord herniation into associated pseudomeningocele after brachial plexus Avulsion Injury case report
Neurosurgery, 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.
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return of spinal reflex after spinal cord surgery for brachial plexus Avulsion Injury
Journal 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 ...
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co treatment with riluzole and gdnf is necessary for functional recovery after ventral root Avulsion Injury
Experimental Neurology, 2004Co-Authors: Astrid Bergerot, P Anand, Peter J. Shortland, 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.
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restoration of hand function and so called breathing arm after intraspinal repair of c5 t1 brachial plexus Avulsion Injury case report
Neurosurgical 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.
Norbert Pallua - One of the best experts on this subject based on the ideXlab platform.
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treatment of Avulsion Injury of three fingers with a compound thoracodorsal artery perforator flap including serratus anterior fascia
Microsurgery, 2009Co-Authors: Dietmar J O Ulrich, Norbert PalluaAbstract:Complete degloving Injury of three digits not amenable to revascularization may leave poor cosmetic and functional results. We used a compound thoracodorsal artery perforator (TDAP) flap in a 34-year-old, right-handed, male worker with traumatic degloving Injury. The flap consisted of a thin nonbulky skin component isolated on two perforators in combination with serratus fascia, both pedicled on the thoracodorsal vessels. The mobility of the two flap components allowed the palmar and dorsal part of the fingers to be reconstructed without relying on multiple flaps or anastomoses. The skin component of the TDAP flap was transferred to the palmar defect, the serratus fascia flap to the dorsal part of the fingers and sutured loosely. Coverage of the serratus anterior fascia was done with split-thickness skin graft. Both components of the flap survived completely. One month after the first operation, the surgical syndactyly between middle and ring finger was separated, one month later the syndactyly between the ring and little finger. Good coverage of the soft tissue defects with good function could be achieved. There were no donor-site problems. Therefore, we consider the compound TDAP flap as a useful method that provides functional and cosmeticcoverage of severe Avulsion Injury of multiple digits. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.
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The use of Integra in an upper extremity Avulsion Injury.
British Journal of Plastic Surgery, 2005Co-Authors: Timm P. Wolter, E.m. Noah, Norbert PalluaAbstract:We present the case of a 22-year-old man who suffered an Avulsion Injury of the left upper extremity including the elbow region in an industrial accident. After debridement of the skin flap, the defect was primarily closed with Integra®. On day 22 split thickness skin graft was performed. Functional and aesthetic outcome and skin quality are excellent.
Xin Zhao - One of the best experts on this subject based on the ideXlab platform.
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evaluation of nerve transfer options for treating total brachial plexus Avulsion Injury a retrospective study of 73 participants
Neural Regeneration Research, 2018Co-Authors: Kaiming Gao, Jie Lao, Xin ZhaoAbstract:Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-Avulsion Injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus Avulsion Injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-Avulsion Injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033).
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outcome of contralateral c7 transfer to two recipient nerves in 22 patients with the total brachial plexus Avulsion Injury
Microsurgery, 2013Co-Authors: Kaiming Gao, Jie Lao, Xin ZhaoAbstract:The treatment of total brachial plexus Avulsion Injury is difficult with unfavorable prognosis. This report presents our experience on the contralateral C7 (CC7) nerve root transfer to neurotize two recipient nerves in the patients with total BPAI. Twenty-two patients underwent CC7 transfer to two target nerves in the injured upper limb. The patients' ages ranged from 13 to 48 years. The entire CC7 was transferred to pedicled ulnar nerve in the first stage. The interval between trauma and surgery ranged from 1 to 13 months. The ulnar nerve was transferred to recipients (median nerve and biceps branch or median nerve and triceps branch) at 2–13 months after first operation. The motor recovery of wrist and finger flexor to M3 or greater was achieved in 68.2% of patients, the sensory recovery of median nerve area recovered to S3 or greater in 45.5% of patients. The functional recovery of elbow flexor to M3 or greater was achieved in 66.7% of patients with repair of biceps branch and 20% of patients with repair of the triceps branch (P < 0.05). There were no statistical differences in median nerve function recovery at comparisons of the age younger and older than 20-years-old and the intervals between trauma and surgery. In conclusion, the use of CC7 transfer for repair two recipient nerves might be an option for treatment of total BPAI. The functional recovery of the repaired biceps branch appeared to be better than that of the triceps branch. © 2013 Wiley Periodicals, Inc. Microsurgery 33:605–611, 2013.