ObjectiveTo investigate the effect of prophylactic C4, 5 foraminal dilatation in posterior cervical open-door surgery on postoperative C5 nerve root palsy syndrome.MethodsThe clinical data of patients with cervical spondylotic myelopathy (cervical spinal cord compression segments were more than 3) who met the selection criteria between March 2016 and March 2019 were retrospectively analyzed. Among them, 40 patients underwent prophylactic C4, 5 foraminal dilatation in posterior cervical open-door surgery (observation group) and 40 patients underwent simple posterior cervical open-door surgery (control group). There was no significant difference between the two groups (P>0.05) in gender, age, disease duration, Nurick grade of spinal cord symptoms, and preoperative diameter of C4, 5 intervertebral foramen, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score. The occurrence of C5 nerve root paralysis syndrome was recorded and compared between the two groups, including incidence, paralysis time, recovery time, and spinal cord drift. VAS and JOA scores were used to evaluate the improvement of pain and function before operation and at 12 months after operation.ResultsThe incisions of the two groups healed by first intention, and there was no early postoperative complications such as cerebrospinal fluid leakage. Patients of both groups were followed up 12-23 months, with an average of 17.97 months. C5 nerve root paralysis syndrome occurred in 8 cases in the observation group (3 cases on the right and 5 cases on the left) and 2 cases in the control group (both on the right). There was significant difference of the incidence (20% vs. 5%) between the two groups (χ2=4.114, P=0.043). Except for 1 case in the observation group who developed C5 nerve root palsy syndrome at 5 days after operation, the rest patients all developed at 1 day after operation; the recovery time of the observation group and the control group were (3.87±2.85) months and (2.50±0.70) months respectively, showing no significant difference between the two groups (t=–0.649, P=0.104). At 12 months after operation, the JOA score and VAS score of cervical spine in the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference in the difference of the cervical spine JOA score and VAS score between at 12 months after operation and before operation and the degree of spinal cord drift between the two groups (P>0.05).ConclusionProphylactic C4, 5 foraminal dilatation can not effectively prevent and reduce the occurrence of postoperative C5 root palsy, on the contrary, it may increase its incidence, so the clinical application of this procedure requires caution.
Objective To investigate the quantity and distribution of motor fiber of rat’s C7 nerve root. Methods Motor fiber quantity and section area in the main nerves of the upper extremity and the fascicles of C7 in 30 SD rats were analyzed.Results Fascicles and certain amount (207) of motor fibers from the anterior division of C7 were distributed to musculocutaneous nerve and median nerve, the orientation of these fibers were not clear. The ones (323) from posterior division were to the axillary, radial, and dorsal thoracic nerves, thus the orientation of these fascicles was relatively definite. Conclusion Thedistribution of the motor fibers and fascicles in the divisions of C7 in rat is similar to human beings, so rat is a relatively good model for the study of selective C7 nerve root transfer.
Objective To provide the anatomical basis of contralateral C7 root transfer for the recovery of the forearm flexor function. Methods Thirty sides of adult anti-corrosion specimens were used to measure the length from the end of nerves dominating forearm flexor to the anastomotic stoma of contralateral C7 nerve when contralateral C7 nerve transfer was used for repair of brachial plexus lower trunk and medial cord injuries. The muscle and nerve branches were observed. The length of C7 nerve, C7 anterior division, and C7 posterior division was measured. Results The length of C7 nerve, anterior division, and posterior division was (58.8 ± 4.2), (15.4 ± 6.7), and (8.8 ± 4.4) mm, respectively. The lengths from the anastomotic stoma to the points entering muscle were as follow: (369.4 ± 47.3) mm to palmaris longus, (390.5 ± 38.8) mm (median nerve dominate) and (413.6 ± 47.4) mm (anterior interosseous nerve dominate) to the flexor digitorum superficialis, (346.2 ± 22.3) mm (median nerve dominate) and (408.2 ± 23.9) mm (anterior interosseous nerve dominate) to the flexor digitorum profundus of the index and the middle fingers, (344.2 ± 27.2) mm to the flexor digitorum profundus of the little and the ring fingers, (392.5 ± 29.2) mm (median nerve dominate) and (420.5 ± 37.1) mm (anterior interosseous nerve dominate) to the flexor pollicis longus, and (548.7 ± 30.0) mm to the starting point of the deep branch of ulnar nerve. The branches of the anterior interosseous nerve reached to the flexor hallucis longus, the deep flexor of the index and the middle fingers and the pronator quadratus muscle, but its branches reached to the flexor digitorum superficials in 5 specimens (16.7%). The branches of the median nerve reached to the palmaris longus and the flexor digitorum superficial, but its branches reached to the deep flexor of the index and the middle fingers in 10 specimens (33.3%) and to flexor hallucis longus in 6 specimens (20.0%). Conclusion If sural nerve graft is used, the function of the forearm muscles will can not be restored; shortening of humerus and one nerve anastomosis are good for forearm flexor to recover function in clinical.
Objective To study the recovery and mechanism of nerve root under variable chronic injury and to determine the alerting index of the evoked potential of the irreversible injury to the nerve root, so as to offer the evidence for selecting treatment methods, judging prognosis and grasping treatment juncture.Methods Autogenous cancellous bones were planted into the right C7-8 and C8T1 intervertebral foramens in 30 cats with weight 3-5 kg to make chronicinjury models. The left side was for auto-contrast. By 24 weeks’ observation anddynamic supervisory of evoked potential, the injury degrees were ascertained and classified into Ⅰto Ⅴdegree groups. Then the operation of decompression was performed on every group. During the following 32 weeks, the evoked potential survey and pathological tissue examination were made every week to observe the function recovery of the injured roots.Results The tissue form and functionof the nerve roots with ⅠandⅡdegree injuries recovered well within 2 to 6 weeks. Those with Ⅲ degree injury began to recover in the 4th week, and graduallyrecovered to normal 12 weeks later. In the group of Ⅳ degree injury, the recoverywas slow. They could recover completely in 3 of 6 cats, partly in 2 and hardly recovered in 1. The function and tissue form of nerve roots with Ⅴdegree injury could hardly recovered. Conclusion In the case that the compression has been removed before the nerve roots suffer Ⅲ degree injury. The tissue form and function of the nerve roots will recovered satisfactorily, whereas they may suffer irreversibly injury by Ⅳdegree injury, and even can hardly recover by Ⅴdegree injury. During the supervisory process of the recovery of the injured nerve roots, sensitive evoked potential is a sensitive sign of early recovery and motion evoked potential is a reliable sign of recovery extent.
ObjectiveTo review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS).MethodsThe related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized.ResultsIn recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology.ConclusionThe minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.
ObjectiveTo observe the possibility of hyper selective neurectomy (HSN) of triceps branches combined with partial neurotomy of S2 nerve root for relieving spastic equinus foot. Methods Anatomical studies were performed on 12 adult cadaveric specimens. The S2 nerve root and its branches were exposed through the posterior approach. Located the site where S2 joined the sciatic nerve and measured the distance to the median line and the vertical distance to the posterior superior iliac spine plane, and the S2 nerve root here was confirmed to have given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. Between February 2023 and November 2023, 4 patients with spastic equinus foot were treated with HSN of muscle branches of soleus, gastrocnemius medial head and lateral head, and cut the branch where S2 joined the sciatic nerve. There were 3 males and 1 female, the age ranged from 5 to 46 years, with a median of 26 years. The causes included traumatic brain injury in 2 cases, cerebral hemorrhage in 1 case, and cerebral palsy in 1 case. The disease duration ranged from 15 to 84 months, with a median of 40 months. The triceps muscle tone measured by modified Ashworth scale (MAC) before operation was grade 3 in 2 cases and grade 4 in 2 cases. The muscle strength measured by Daniels-Worthingham manual muscle test (MMT) was grade 2 in 1 case, grade 3 in 1 case, and 2 cases could not be accurately measured due to grade 4 muscle tone. The Holden walking function grading was used to evaluate lower limb function and all 4 patients were grade 2. After operation, triceps muscle tone, muscle strength, and lower limb function were evaluated by the above grading. Results The distance between the location where S2 joined the sciatic nerve and median line was (5.71±0.53) cm and the vertical distance between the location and posterior superior iliac spine plane was (6.66±0.86) cm. Before joining the sciatic nerve, the S2 nerve root had given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. All the 4 patients successfully completed the operation, and the follow-up time was 4-13 months, with a median of 7.5 months. At last follow-up, the muscle tone of the patients decreased by 2-3 grades when compared with that before operation, and the muscle strength did not decrease when compared with that before operation. Holden walking function grading improved by 1-2 grades, and there was no postoperative hypoesthesia in the lower limbs. Conclusion HSN of triceps branches combined with partial neurotomy of S2 nerve root can relieve spastic equinus foot without damaging other sacral plexus nerves.
Objective To observe the recovery of the sensory and motor function of the repaired l imb and the impact on the healthy l imb function after contralateral C7 nerve root transposition for treating brachial plexus root avulsion injury. Methods Between August 2008 and November 2010, 22 patients with brachial plexus root avulsion injuries were treated with contralateral C7 nerve root transposition. All patients were male, aged 14 to 47 years (mean, 33.3 years). Total brachialplexus root avulsion was confirmed by preoperative cl inical examination and electrophysiological tests. In 22 cases, median nerve was repaired in 16 cases, radial nerve in 3 cases, and musculocutaneous nerve in 3 cases; primary operation was performed in 2 patients, and two-stage operation was performed in 20 patients. The sensory and motor functional recovery of the repaired limb was observed after operation. Results Twenty-one patients were followed up 7-25 months (mean, 18.4 months). In 16 cases of contralateral C7 nerve root transposition to the median nerve, wrist flexors reached more than M3 in 10 cases, while finger flexors reached more than M3 in 7 cases; sensation reached more than S3 in 11 cases. In 3 cases of contralateral C7 nerve root transposition to the musculocutaneous nerve, elbow flexors reached more than M3 in 2 cases; sensation reached more than S3 in 2 cases. In 3 cases of contralateral C7 nerve root transposition to the radial nerve, wrist extensor reached more than M3 in 1 case; sensation reached more than S3 in 1 case. Conclusion Contralateral C7 nerve root transposition is a good procedure for the treatment of brachial plexus root avulsion injury. Staged operation is one of important factors influencing treatment outcome.
ObjectiveTo evaluate the methods and effectiveness of contralateral C7 nerve root and multiple nerves transfer for the treatment of brachial plexus root avulsion. MethodsBetween June 2006 and June 2010, 23 patients with brachial plexus root avulsion were treated. There were 20 males and 3 females, aged 17 to 42 years (mean, 27.4 years). The time from injury to operation was 4 to 12 months (mean, 5.9 months). In 16 patients having no associated injury, the first stage procedure of contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve or phrenic nerve transfer to anterior upper trunk was performed, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and intercostal nerve transfer to axillary nerve was performed. In 4 patients having phrenic nerve and accessory nerve injuries, the first stage procedure of the contralateral C7 nerve root transfer and second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. In 3 patients having hemothorax, pneumothorax, and rib fractures, the first stage procedure of the contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. The British Medical Research Council (MRC) sensory grading (S0-S4) and modified muscle strength grading standard (M0-M5) were used for comprehensive assessment of limb and shoulder abduction, elbow/biceps muscle strength, flexor wrist and finger muscle strength and median nerve sensory recovery. ResultsTwenty-three patients were followed up 3-4.5 years (mean, 3.4 years). At 3 years after operation, the shoulder abduction reached 0-82°(mean, 44°). In 16 patients having no associated injuries, the shoulder abduction was more than 30°in 13 cases, and was more than 60°in 3 cases; in 3 patients having hemothorax, pneumothorax, and rib fractures, the shoulder abduction was more than 30°; and in 4 patients having phrenic nerve and accessory nerve injuries, the shoulder abduction was 0°. The muscle strength of elbow/biceps was M3 or more than M3 in 9 cases, was M1-M2 in 8 cases, and was M0 in 6 cases; the muscle strength of flexor wrist or finger was M3 or more than M3 in 7 cases, was M1-M2 in 11 cases, and was M0 in 5 cases. Median nerve sensory recovery was S3 or more than S3 in 11 cases, was S1-S2 in 7 cases, and was S0 in 5 cases. After 3 years, affected limb had locomotor activity in 11 patients, affected limb had activities driven by the contralateral latissimus dorsi muscle contraction in 12 patients. ConclusionContralateral C7 nerve root and multiple nerves transfer is a good method to treat brachial plexus root avulsion.
ObjectiveTo review the research progress of C5 palsy (C5P) after cervical surgery, providing new clinical intervention ideas for the C5P patients. MethodsThe relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence, risk factors, manifestations and diagnosis, prevention, and intervention measures of C5P were systematically expounded. ResultsC5P is characterized by weakness in the C5 nerve innervation area after cervical decompression surgery, manifested as limited shoulder abduction and elbow flexion, with an incidence rate more than 5%, often caused by segmental spinal cord injury or mechanical injury to the nerve roots. For patients with risk factors, careful operation and preventive measures can reduce the incidence of C5P. Most of the patients can recover with conservative treatment such as drug therapy and physical therapy, while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement. ConclusionCurrently, there has been some advancement in the etiology and intervention of C5P. Nevertheless, further research is imperative to assess the timing of intervention and surgical protocol.
Objective To observe the result of reconstructing quadriceps femoris function in the paraplegia rats by using the 7th cervical nerve root (C7) transposition with autologous and allogeneic neural transplantation. Methods Twenty16-week-old SPF male Wistar rats were adopted to prepare frozen sciatic nerve. Thirty-six Wistar rats were divided into 2 groups (group A and group B, n=18). The left paraplegia model was establ ished with left spinal cord hemisection by the micro scissors under the operation microscope. After the model establ ishment, the homolateral autologous sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group A, while the allogeneic sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group B. At 16 weeks and 24 weeks after operation, 9 rats in each group were selected for the neuroelectric-physiological test and then the histomorphology of the nerves was observed under the microscope and the electron microscope. The fresh weight recovery rate of quadriceps femoris was calculated. Results At 16 and 24 weeks after operation, the nerve action-evoked potential (NAP) was (1.14 ± 0.07) mV and (1.21 ± 0.07) mV in group A, and (0.87 ± 0.06) mV and (0.99 ± 0.05) mV in group B; the nerve conduction velocity (NCV) was (17.34 ± 2.15) m/s and (19.00 ± 3.02) m/s in group A, and (11.23 ± 1.45) m/s and (12.54 ± 1.59) m/s in group B, respectively, indicating significant differences (P lt; 0.05) between 2 groups. At 16 and 24 weeks after operation, HE staining and Bielschowsky staining showed that group A had a large number of nerve fiber regeneration, with a regular arrange of axons; while group B had l ittle nerve fiber regeneration with a scattered arrange of axons. At 24 weeks after operation, images in TEM showed a large number of regeneration myel inated nerve fibers and a small number of unmyel inated nerve fibers through the transplanted nerve in two groups. At 16 weeks after operation, the number of myel inated nerve fibers in group A and group B was (438 ± 79) and (196 ± 31) / vision, the areas of myel inated nerve fiberswere (5 596.00 ± 583.94) and (4 022.63 ± 615.75) μm2 / vision; after 24 weeks, the number of myel inated nerve fibers in groups A and B were (642 ± 64) and (321 ± 75)/vision, the areas of myel inated nerve fibers were (6 689.50 ± 1 142.10) and ( 4 733.00 ± 982.22) μm2/vision, indicating significant differences between two groups (P lt; 0.05). There was no statistically significant difference (P gt; 0.05) in the wet weight recovery rate of quadriceps between group A and group B at 16 weeks (87.96% ± 4.93% vs. 86.47% ± 7.47%) and at 24 weeks after operation (90.10% ± 4.22% vs. 87.66% ± 3.14%). Conclusion C7 transposition combined with autograft and allograft of sciatic nerve can reconstruct the partial function of the quadriceps femoris in paraplegia rats. The effect of graft is better than that of graft obviously.