Effect of repetitive peripheral magnetic stimulation on upper limb motor function of stroke patients after contralateral seventh cervical nerve transfer / 中国康复理论与实践

ObjectiveTo explore the effect of repetitive peripheral magnetic stimulation on upper limb motor function rehabilitation of stroke patients after contralateral seventh cervical nerve transfer (CC7). MethodsFrom May, 2020, to May, 2022, 34 stroke patients with hemiplegia underwent CC7 in Jing'an District Centre Hospital of Shanghai were randomly divided into control group (n = 17) and observation group (n = 17). Both groups received conventional rehabilitation. The observation group accepted repetitive peripheral magnetic stimulation, and the control group received sham stimulation, for eight weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Hua-Shan Grading of Upper Extremity (H-S grading) before and after treatment. ResultsTwo cases dropped down in each group. There was difference in gender between two groups (χ2 = 6.136, P < 0.05). After treatment, the scores of FMA-UE and H-S grading significantly improved in both groups (t > 4.000, P < 0.01), and the improvement was better in the observation group than in the control group (t > 2.362, P < 0.05). ConclusionRepetitive peripheral magnetic stimulation could improve the motor function of upper limb and hand of stroke patients with hemiplegia after CC7.

Neuroinflammation Mediates Faster Brachial Plexus Regeneration in Subjects with Cerebral Injury / 神经科学通报·英文版

Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel's test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.

Neuroinflammation Mediates Faster Brachial Plexus Regeneration in Subjects with Cerebral Injury / 神经科学通报·英文版

Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel’s test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.

Research progress in minimally invasive treatment of cervical nerve root canal stenosis under total endoscope / 中国修复重建外科杂志

Objective: To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS). Methods: The 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. Results: In 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. Conclusion: The 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.

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective@#To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.@*Methods@#A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.@*Results@#All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively.@*Conclusion@#Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014.Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recov鄄ered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the muscu鄄locutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3.In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Application of ultrasound-guided selective cervical nerve root block for patients undergoing arthroscopic surgery in perioperative period / 临床麻醉学杂志

Objective To compare effectiveness,performance,and complications between ultrasound-guided selective cervical nerve root block and interscalene brachial plexus block for patients undergoing arthroscopic surgery in perioperative period.Methods Seventy patients scheduled for arthroscopic surgery,25 males and 45 females,aged 18-75 years,were randomly divided into two groups.They were given either selective cervical nerve root block (group S,n =35) or interscalene brachial plexus block (group ISB,n=35).In group S,C5 and C6 nerve roots were given 0.5％ ropivacaine 5 ml respectively;In group ISB,patients were given 0.5％ ropivacaine 10 ml under ultrasound guidance.The primary outcome:VAS score and forearm modified Bromage scale (MBS) score were recorded at 4,12 and 24 hours after surgery;Secondary outcomes:cumulative tramadol consumption,the patients' satisfaction rate and adverse effects were recorded.Results The VAS scores in group S was significantly lower than that in group ISB at 12 hours after surgery (1.7±0.8 vs 3.6±0.7,P＜0.05).The forearm MBS scores in group S was significantly higher than that in group ISB 4 hours after surgery (P＜0.01).Compared with group ISB,the amount of tramadol consumption was lower at 24 hours after surgery [(37.5±35.9) mg vs (112.5±43.5) mg,P＜0.05)].The satisfaction rate of group S was higher than group ISB (88％ vs 56％,P＜0.05).There was no significant difference in side effects between the two groups.Conclusion In arthroscopic surgery,the selective cervical nerve root block is superior to the brachial plexus block.

Cervical Nerve Root Neurolymphomatosis Detected on F-18 FDG PET/CT / 계명의대학술지

A 65-year-old woman was treated with chemotherapy for diffuse large B-cell lymphoma (DLBCL) after presenting with sharp pain of the left arm. She had complete remission of the DLBCL, and symptoms disappeared. One year after treatment, she developed sharp pain in the first through third fingers that extended to the left arm. F-18 FDG PET/CT showed linear increased FDG uptake along the cervical nerve roots and plexus at the C4-C7 levels, suggesting neurolymphomatosis. Gadolinium-enhanced MRI showed enhancement and enlargement of the cervical nerve root and plexus. Fine needle aspiration biopsy of the left cervical nerve confirmed DLBCL.

On the Variations of Cervical Dermatomes.

Background: Nerve-root related dermatomes have been considered to have quite solid anatomical framings. However, especially in the lumbar region, studies have questioned such firm anatomy. Regarding the cervical nerve roots, many studies have shown an overlap between different dermatomes, which of course affects decisions taken in the clinical work. All the same, dermatome drawings with clear borders are still widely used. Context and purpose of the study: We conducted a literature review in order to find today’s state of the art, including the methods on which the anatomical atlases have been based. The overall pragmatic thoughts were to create summarized guide for clinicians when trying to correlate an MRI-demonstrated prolapse/recess stenosis to pain and neurologic findings, particularly if the nerve root’s peripheral neurology does not follow conventional anatomy. Results: We isolated 24 studies that sufficiently dealt with the issue of cervical dermatomes. Pain and sensory disturbance caused by cervical root affection could deviate from the dermatomal patterns. We found indications that sometimes no paralysis or anaesthesia would be seen after section of a single root. Because the fraction of cases without classical fit between nerve root and anatomical level cannot be given, studies should go into this issue. Conclusion: There are many studies showing that dermatomal distributions are varying, and not only overlapping. We therefore mean that new studies, with modern imaging and surgical techniques, are much needed.

Anatomy of the frst spinal nerve: a review

In this simple review we discuss some important anatomical and functional aspects of the first cervical nerve (C1). The C1 has considerable clinical importance, and the particulars of this nerve are conflicting among several authors, thus, the present review shall be essential for health sciences and those who keep some interest in pathologies associated with the nerves of the neck. For the preparation of this text were consulted papers published in English and textbooks. The articles were accessed from a basic search on SciELO, MEDLINE, PubMed, LILACS, Google Scholar and ScienceDirect.

Anatomic Confirmation of the Motor Fibers in the Cervical Nerves Innervating to the Trapezius Muscle / 체질인류학회지

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.

Anatomic Confirmation of the Motor Fibers in the Cervical Nerves Innervating to the Trapezius Muscle / 체질인류학회지

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.

The Effect of Stellate Ganglion Block on Herpes Zoster / 대한피부과학회지

BACKGROUND: Stellate ganglion block has been proposed as one of the effective therapetic modalities for herpes zoster. However, the effect on the reduction of acute herpes zoster pain and postherpetic neuralgia is not well known. OBJECTIVE: To evaluate the reduction of acute herpes zoster pain and the prevention of postherpetic neuralgia by stellate ganglion block. METHODS: Twenty one patients with herpes zoster were included in this study, and were divided into two groups: the group treated with I.V acyclovir, analgesics and stellate ganglion block during 7-days of a hospitalization period, and a control group which were treated with I.V acyclovir and analgesics alone. To evaluate it's effect on pain, the score of pain presented by patients, where initial pain was defined as 100 and no pain defined as 0, was recorded and compared between the groups. RESULTS: An average day required for the relief of pain was significantly shorter in the treated group than the control group: the average number of days needed to reduce the pain score from 100 to 50, implicating relief of acute pain, was 2.3 days, compared to 3.7 days in the control group (p=0.036). The total duration of pain, implicating postherpetic neuralgia, was also significantly shorter in the treated group (17.4 days) than the control group (42.3 days) (p=0.035). CONCLUSION: Stellate ganglion block is an effective method which can be used to relieve acute herpes zoster pain involving the trigerminal and cervical nerves, and can prevent postherpetic neuralgia.

Applied microanatomy of cervical nerve and its related structure / 第三军医大学学报

Objective To study the course of different cervical nerve segments and their related intervertebral foramen’s size so as to increase safety and decrease complications in microinvasive surgery for cervical syndrome. Methods Fifteen human cervical specimens (30 sides) were anatomically observed for the course, branches and distribution of cervical nerves. Results The diameter of intervertebral foramen ranges from 0.54 to 0.65 cm, and increases gradually from top to bottom. The vertical diameter and anteroposterior diameter between C4, C5 and C6 vertebrae are smaller, and those between C3 and C7 are larger, but the diameter line of nerve root in intervertebral foramen from up to down gradually increases. The anteversion angle between nerve root and spine cord on horizontal plane is from 15? to 19?, within a small variation, while the declination angle on coronal plane gradually decreases from C3 to C7. There exist plenty of anastomosis branches among the cervical dorsal rami. Conclusion In the range of 0.6 cm around articular process at the entrance of intervertebral foramen, it is the narrowest part, the removal of which may alleviate the pressure on nerve root and benefit spinal stability. Because of the general existence of anastomosis branches of cervical nerve, the symptoms of cervical syndrome are not completely consistent to innervation. The intervertebral foramen between C4, C5, C6 is relatively small and the diameter line of nerve root is comparatively large, so the nerve root at C4, C5, C6 is most likely to be pressed.