The clinical value analysis of MRN on diagnosis and treatment of lumbosacral nerve injury associated with sacral fractures / 中华骨科杂志

Objective:To discuss the clinical value of magnetic resonance neurography (MRN) on diagnosis and treatment of lumbosacral nerve injury associated with sacral fractures and analyze the characters of nerve injury which was caused by sacral fractures.Methods:The clinical data of 40 patients who had lumbosacral nerve injury associated with sacral fractures and accepted treatment in Tianjin hospital from August 2018 to December 2020 were collected based on inclusion and exclusion criteria. Twenty-four patients had unilateral sacral fractures (Tile C1) which included 16 Denis II type fractures and 8 Denis III type fractures. Sixteen patients had bilateral sacral fractures which were all Tile C3, U shaped and Denis II type sacral fractures. All patients had symptoms or signs of lumbosacral nerve injury, and accepted contrast-enhanced three-dimensional magnetic resonance neurography (CE-3D MRN) to diagnose the injury part and severity degree. The L 5-S 4 nerves were separated to three parts based on injured side and intraspinal type (IS), intraforaminal type (IF) and extraforaminal type (EF) location, and were judged the mild, medium or severe degree of nerve injury severity. Overall and pairwise Chi-square test was performed on the number of nerve injuries. Eleven patients accepted the operation of nerve dissection and exploration. The nerve injury part and severity were recorded under direct vision, and were statistically analyzed with CE-3D MRN outcome. Results:The outcome of 239 lumbosacral nerve injuries which had different part and severity were found by MRN, and all combined with sacral fractures of the same side. The nerves which ranked from largest to fewest according to injured numbers were L 5, S 1, S 2, S 3 and S 4. The statistical analysis showed that there were significant differences of injured nerve numbers except between S 1 and S 2, S 3 and S 4, and there were no significant difference of nerve injury part and severity degree between the direct visual judgement intraoperatively and preoperative CE-3D MRN examination. Conclusion:MRN can reveal the part and severity degree of lumbosacral nerve injury associated with sacral fracture clearly and accurately, which has important clinical value and should become the preferred examination of such injuries. The lumbosacral nerve injury has the most frequent features of S 1 and S 2, followed by L 5, and the least in S 3 and S 4.

Description of brachial plexus of sloth (Bradypus variegatus) / Descrição do plexo braquial do bicho-preguiça (Bradypus variegatus)

The species Bradypus variegatus is known as the common sloth, an endemic mammal from neotropical regions, which has been suffering from devastating anthropogenic activities. Our study aimed to describe the brachial plexus of B. variegates, regarding the origin and distribution of nerves, through the sampling of 10 adult females. Analyses were carried out at the Anatomy Section, "Departamento de Morfologia e Fisiologia Animal", "Universidade Federal Rural de Pernambuco", under license no. 034/2015 of the Ethics Committee on the Use of Animals. The results determined that the brachial plexus of the common sloth starts from the fifth cervical spine segment until the second thoracic segment. This area contains the long and suprascapular thoracic nerves, which originate immediately from the medullary segment 5 and 6, respectively, and from the pectoral, subscapular, axillary, radial, musculocutaneous, medial, forearm and ulnar medial cutaneous nerves, arising from a trunk comprised of cervical spine nerves (C) 7, C8, C9, and thoracic (T) 1 and T2. Regarding other wild and domestic animals, different suggestions were observed about the origin of the plexus in B. variegatus, however, the constituent nerves and their innervation areas did not demonstrate any discrepancies.(AU)

A espécie Bradypus variegatus é conhecida como preguiça-comum. Trata-se de um mamífero endêmico de regiões neotropicais que vem sofrendo com a ação antrópica devastadora. Esses Bradipodídeos possuem três dedos nos membros torácicos e pélvicos, são arborícolas consagrados e descem ao solo apenas para excretar e trocar de árvore. O estudo teve como objetivo descrever o plexo braquial de B. variegatus em relação à origem e distribuição dos nervos. Para tal, utilizou-se 10 fêmeas adultas. As análises foram realizadas no Pavilhão de Anatomia do Departamento de Morfologia e Fisiologia Animal da Universidade Federal Rural de Pernambuco, sob a licença nº 034/2015 do Comitê de Ética no Uso de Animais. Os cadáveres foram obtidos após morte natural, fixados em formaldeído a 20%, conservados em solução salina a 30% em tanques e dissecados para a visualização dos nervos destinados a inervar os membros e músculos torácicos. Uma vez feito, constatou-se que o plexo braquial da preguiça-comum se origina do quinto segmento espinal cervical, se estendendo até o segundo segmento torácico. Sendo formado pelos nervos torácico longo e supraescapular, de origem imediatamente do segmento medular 5 e 6, respectivamente, e pelos nervos peitorais, subescapulares, axilar, radial, musculocutâneo, mediano, cutâneo medial do antebraço e ulnar, decorrentes de um tronco formado a partir de nervos espinais cervicais (C) 7, C8, C9, e torácicos (T) 1 e T2. Em comparação a outros animais silvestres e domésticos foram observadas diferentes disposições em relação à origem do plexo de B. variegatus, todavia, os nervos constituintes e suas áreas de inervação não apresentaram discrepâncias.(AU)

Utilidad de la 18F-FDG PET/TC en la valoración de tumores de la vaina nerviosa / The Value of 18F-FDG PET/TC in the Assessment of Peripheral Nerve Sheath Tumors

La 18F-FDG PET/TC tiene un papel importante en la evaluación de los tumores de la vaina nerviosa periférica, especialmente para determinar la posibilidad de malignidad y el sitio idóneo para la toma de biopsia. Se expone el caso de una mujer de 34 años de edad con diagnóstico de tumor de vaina nerviosa periférica, localizado en el mediastino posterior, que generó síndrome de vena cava superior y síndrome de Horner. Se realizó 18F-FDG PET/TC para hacer el diagnóstico diferencial entre benignidad y malignidad. Se encontró masa heterogénea con áreas hipermetabólicas que alcanzaban un SUVmax (valor de captación estándar máximo) de 8,5, hallazgos que sugerían origen maligno con diferentes grados de diferenciación. La biopsia de los lugares con mayor metabolismo arrojó el resultado de tumor maligno de vaina nerviosa periférica.

18F-FDG PET/CT is a useful imaging modality in the diagnosis and follow-up of peripheral nerve sheath tumors, especially in the assessment of tumor grade and biopsy guidance. The case of a 34-years-old woman diagnosed with peripheral nerve sheath tumor located in the posterior mediastinum that generated superior vena cava syndrome and Horner syndrome is presented. 18F-FDG PET/TC was performed to assess the possibility of malignancy. An 18F-FDG PET/CT was performed to determine whether it was benign or malignant, a heterogeneous mass with hypermetabolic areas with a maximum standardized uptake value (SUVmax) of 8.5 was found, and suggested malignancy with multiple grades of differentiation. A tumor biopsy from the region of higher metabolism was recommended with pathology result of malignant peripheral nerve sheath tumor.

Preliminary study on spinal nerve coding and injury typing / 中华创伤杂志

Currently,there is no study on the unified coding of the spinal nerve and its main branches.The positions of spinal nerve were encoded according to the basic anatomical principles from top to bottom,from inside to outside and from front to back,with reference to AO bone classification and somatic artery coding and injury classification system.The segmental coding of spinal nerves was decided by its branches and running characteristics.The spinal nerve injuries were encoded by a combination of numbers and letters.The first number represented the region,the second represented the injured nerve,and the third represented the specific segment of injured nerve.The injuries of spinal nerve were divided into 5 categories according to severity.The first letter indicated the category of injury,and the second indicated the orientation of the injured nerve.The functional score scale of the innervation area was prepared based on the evaluation of motor function,sensory function and the results of neurophysiological examination.This scale was used to classify the neurological injuries,guide the clinical treatment and evaluate the prognostic outcomes.This coding and classification system can clearly and comprehensively describe the location and type of spinal nerve injuries,and it is convenient for the diagnosis of nervous system damage.It also has important reference value for treatment and prognosis evaluation.

Quiste de Tarlov sintomático. Presentación de un caso / Syntomatic Tarlov Cyst. Case presentation

Los quistes de Tarlov o quistes perineurales son formaciones patológicas localizadas en el espacio comprendido entre el perineuro y endoneuro de las raíces espinales posteriores cercanas al ganglio radicular posterior. Es una enfermedad poco frecuente. Aunque su etiología es incierta se han postulado diferentes teorías desde su descubrimiento. Habitualmente son asintomáticos, se descubren como hallazgos incidentales en estudios de imagen. Se presenta el caso de una paciente aquejada de lumbociatalgia de un mes de evolución, sin relación con esfuerzos ni traumatismos previos. El estudio por imágenes permitió el diagnóstico de quiste de Tarlov, que en este caso se manifestó de una forma atípica, por lo que podría confundirse con otras afecciones a nivel lumbosacro.

Tarlov or perineural cysts are pathologic deformations located in the space between the Perineurium and endoneurium of spinal roots close to the posterior root ganglion. It is an infrequent disease. Although its etiology is uncertain different theories have been postulated since its discovery. Regularly they are asymptomatic; they are discovered as incidental findings in imaging studies. A case is presented of a patient complaining of a lumbociatalgia of month evolution, without relation with previous efforts or traumas. Imaging studies allowed the diagnosis of Tarlov Cysts, which in this case presented atypically, so it could be confused with other affections of the lumbosacral level.

Feasibility of diffusion tensor imaging in lumbosacral neuropathy / 中华放射学杂志

Objective To study the feasibility of diffusion tensor imaging(DTI) in assessment of lumbosacral neuropathy. Methods Eighteen patients with lumbosacral neuropathy (experimental group) and 20 healthy volunteers (control group) were enrolled prospectively in the neurological department by clinical symptoms and neuroelectrophysiology. The experimental group were divided into experimental subgroup A(demyelination group, 6 cases),subgroup B(axonal injury with demyelination group, 12 cases) based on electrophysiology.All of L4-SN nerves of the experiment group and the control group received DTI examination."Sowing points"as ROIs were placed in the proximal, middle and distal of bilateral L4-SN nerves by two experienced physicians.The average of the DTI parameters of 3 ROIs at each nerve were used as its final DTI parameters.Independent sample t test was used to evaluate the difference of the L4-SN DTI parameters between the experimental group and the control group.The differences of DTI parameters among the control group, the experimental subgroup A and the experimental subgroup B were compared by the nonparametric independent samples Kruskal-Wallis H test and the Nemenyi test. The ROC analysis was performed on the FA values and λ⊥values of the control and experimental groups.Results (1)The L4-SN FA values in the experimental group was significantly lower than those in the control group (t range from 4.11 to 6.36, P<0.05). The L4 and S1-SN ADC values of the experimental group were significantly higher than those of the control group (t range from - 4.77 to - 1.17, P<0.05). The L4-SN λ ⊥ values in the experimental group were significantly higher than those in the control group (t range from -5.30 to -2.57，P< 0.05). (2) L4-SN FA values (H values ranged from 18.5 to 30.6, P<0.05), λ⊥ values (H values ranged from 6.8 to 29.2, P<0.05) and L4, S1-SN ADC values (H values ranged from 6.8 to 19.6, P<0.05) were significantly different among control group, experimental subgroup A and experimental subgroup B. Nemenyi test showed there were significant differences in FA values (H values ranged from 18.4 to 30.1,P<0.05) and λ⊥ values (H values ranged from 6.2 to 29.0, P<0.05)) of L4-SN and in ADC values (H values ranged from 6.4 to 19.54, P<0.05) of L4，S1-SN between control group and experimental subgroup B. (3) The analysis of ROC of the experimental group and control group showed the AUC values of L4-SN FA values were 0.834, 0.745, 0.860, 0.772, 0.811 respectively, the sensitivity were 66.7%, 72.2%, 77.8%, 83.3% and 66.7% respectively, and the specificity were 91.7%,69.4%,80.6%,61.1% and 88.9% respectively. The AUC values of L4-SN λ⊥ values were 0.796, 0.656, 0.791, 0.701, 0.843 respectively, and the sensitivity were 55.6%, 50.0%, 66.7%, 97.2% and 88.9% respectively,and the specificity were 91.7% , 77.85% , 86.1% , 36.1% and 66.7% respectively. Conclusion DTI has the feasibility to evaluate lumbosacral neuropathy and it can identify patients with axonal injury with demyelination and healthy subjects.

Distribution characteristics of the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints and its clinical significance / 局解手术学杂志

Objective To examine the distribution characteristics the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints, so as to explore the localization and targeting of the medial branch of the posterior branch in neurectomy.MethodsFive corpses were dissected, and the anatomical relationships between the medial branches of the posterior branch of the spinal nerves and the facet joints were examined.Measured the distances from the lateral port of the bone fiber tube,the articular process of the facet joint and the superior articular process to the spinous processes.Results The medial branch of the posterior branch of the spinal nerve was close to the root of the articular process and the transverse process,which was not easy to be explored and dissected.Meanwhile, it was easily traced after the medial branch of the posterior branch of the spinal nerve ran through the fibrous tube.Conclusion It may improve the safety and effective when the techniques of medial branch block is performed after the medial branch ran through the fibrous tube.

Surgical Anatomy Of Dorsal Root Entry Zone of Cervical Spinal Nerves – Cadaveric Study.

Background: The main purpose of this study is to determine the detailed morphometric data of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves. This knowledge is necessary for diagnosis, treatment and surgical management of pain due to many conditions like brachial plexus avulsion injury, post-herpetic neuralgia, phantom pain and cancer pain involved in cervical myelo-radiculopathy. There are fewer studies reported in this field of DREZ. Materials and Methods: Twenty five adult formalin fixed cadavers are taken for this study. Conventional Spinal cord dissection is followed as per Cunningham’s Dissection Mannual. Findings: The parameters included are Number of dorsal rootlets, Longitudinal Length of DREZ, Distance between two successive DREZ, Length of dorsal rootlets, Distance between right and left DREZ, Distance between DREZ and Ligamentum denticulatum, Cranial angles of Superior & inferior rootlets. Results: Results were noted for all the parameters and are compared with the previous studies. The significant observations are obtained. Conclusion: Surgical anatomy of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves will be useful for the neurosurgeons doing Drezotomy procedure, in which the nociceptive fibres alone are specifically severed with preservation of other sensations.

Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome

OBJECTIVE: Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. METHODS: This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy. RESULTS: The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment. CONCLUSION: It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.

Origem e distribuição do nervo axilar em fetos de bovinos azebuados / Origin and distribution of the axillary nerve in zebu-crossed bovine fetuses

A origem e distribuição do nervo axilar foram analisadas por meio da dissecação em 30 fetos de bovinos azebuados, 20 machos e 10 fêmeas, após a fixação em solução aquosa de formaldeído a 10%. O nervo axilar originou-se em 13,33% dos antímeros do ramo ventral do sexto nervo espinal cervical (C6), em 100% dos antímeros do ramo ventral do sétimo nervo espinal cervical (C7), em 91,67% do ramo ventral do oitavo nervo espinal cervical (C8) e em 5,00% do ramo ventral do primeiro nervo espinal torácico (T1). O nervo axilar cedeu ramos para os músculos redondo menor (100,00%), deltóide (100,00%), parte cleidobraquial do músculo braquiocefálico (100,00%), subescapular (78,33%) e redondo maior (11,66%). Em todos os animais o referido nervo emitiu o ramo cutâneo cranial do antebraço, o qual se distribuiu para a fáscia e pele da face cranial do braço e antebraço. Não houve diferenças significativas entre as frequências de ramos dos nervos axilares emitidos para os músculos dos antímeros direito e esquerdo, entretanto, constataram-se diferenças estatísticas entre a frequência de ramos cedidos para o músculo deltóide direito, em machos e fêmeas, sendo observada uma maior frequência para os fetos machos.

In this study, the origin and distribution of the axillary nerve in 30 fetuses of zebu-crossed bovines, 20 males and 10 females, were analyzed through dissection after fixation in an aqueous solution of 10% formaldehyde. The axillary nerve was found to originate in 13.33% of the antimeres of the ventral branch of the 6th cervical (C6) spinal nerve, in 100% of the antimeres of the ventral branch of the 7 th cervical (C7) spinal nerve, in 91.67% of the ventral branch of the 8th cervical (C8) spinal nerve, and in 5.00% of the ventral branch of the 1st thoracic (T1) spinal nerve. The axillary nerve extended branches to the teres minor (100,00%), deltoid (100,00%), cleidobrachial part of the brachiocephalic muscle (100,00%), subscapularis (78.33%) and teres major (11.66%) muscles. In all the animals, the aforementioned nerve issued the forearm cranial cutaneos branch, which was distributed to the fascia and skin of the cranial face of the arm and forearm. No significant differences were found in the frequency of branches of the axillary nerves issuing to the muscles of the right and left antimeres. However, statistically significant differences were found in the frequency of branches leading to the right deltoid muscle in males and females, with male fetuses showing a higher frequency of these branches.

Xenotransplante de células mesenquimais de tecido adiposo humano em modelo de lesão de raízes ventrais da medula espinal de rato / Xenotransplantation of mesenchymal stem cells from human adipose tissue in a rat model of ventral root lesions of the spinal cord

A avulsão de raízes motoras, na interface do sistema nervoso central e periférico, já bem descrito na literatura, promove uma significativa perda sináptica com degeneração de cerca de 80% dos motoneurônios afetados. Não existem estratégias eficazes que propiciem uma reversão ou amenização deste quadro, mas alguns estudos já mostram que o passo fundamental é preservar os motoneurônios afetados. Pesquisas em diferentes áreas com células-tronco (CT) adultas estão sendo realizadas nos últimos anos e apresentam resultados promissores para a medicina regenerativa. Investigações recentes têm apontado para diferentes fontes de CT em tecidos adultos tais como de medula óssea, de sangue de cordão umbilical, tecido muscular, tecido nervoso, líquido amniótico entre outras. De modo geral, estas células apresentam como características principais a capacidade de proliferação e a diferenciação para outros tipos celulares. Entretanto, os principais problemas para o uso clínico das CT adultas são: i) pequena quantidade de células multipotentes, ii) o controle da diferenciação, iii) insuficiência no número de células viáveis e iiii) difícil obtenção. Como alternativa às dificuldades anteriormente citadas, o tecido adiposo tem sido foco de intensos estudos, pois este tecido possui rica fonte de células pluripotentes, além de apresentarem características positivas como fácil acesso ao tecido adiposo subcutâneo, obtenção em quantidade abundante e processo de isolamento celular relativamente simples. Apesar deste tecido apresentar organização complexa, é na fração celular do estroma vascular que se encontra uma rica população de células pluripotentes. Dados de literatura demonstram que as células mesenquimais derivadas de tecido adiposo (AT-MSC - Células mesenquimais de tecido adiposo), mediante incubação com meios de cultura variados, diferenciam-se em adipócitos, osteócitos, mioblastos, hepatócitos, células vasculares entre outras.

It is well described in the literature that avulsion motor at the interface of the central and peripheral nervous system, promotes a significant loss of synaptic degeneration and 80% of motor neurons death. There is no effective strategies that favor a reversal or mitigation of this framework, but some studies have shown that the key step is to preserve motor neurons affected. Researches in different areas with stem cell (CT) adults are being undertaken in recent years and show promising results for regenerative medicine. Recent investigations have pointed to different sources of CT in adult tissues such as bone marrow, umbilical cord blood, brain, muscle tissue, amniotic fluid, among others. Generally, these cells have as main characteristics capacity for proliferation and differentiation to other cell types. However, the main problems for the clinical use of adult SC are: i) small amount of multipotent cells, ii) differentiation control, iii) low number of viable cells and iiii) difficulty to obtain. As an alternative to the difficulties mentioned above, adipose tissue has been the focus of intense study, because this tissue has a rich source of stem cells, in addition to having positive characteristics such as easy access to subcutaneous adipose tissue, obtained in abundant quantities and isolation process relatively simple. Despite the complex tissue organization, the stromal vascular fraction is rich of pluripotent population cells. Literature data show that stromal cells derived from adipose tissue (AT-MSC-adipose tissue mesenchymal stem cells) can differentiate by incubation with various culture media into adipocytes, osteocytes, myoblasts, hepatocytes, vascular cells, among others. The AT-MSC differentiation into neuronal cells is still subject of discussion and criticism in literature, since no established protocol has induced differentiation into function neuronal cells.

The clinical research of restoring the global upper limber function in traumatic total brachial plexus avulsion injuries / 中华骨科杂志

Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.

Experimental study of reconstruction of hindlimp movement with spinal ventral root anastomoses after spinal cord injury in rats / 中华显微外科杂志

Objective To establish a paraspinal neural pathway of quadriceps femoris by end-to-end anastomoses between the spinal ventral root after spinal cord injury(SCI) in rats. Methods Twenty-fourweek old SD rats, with the weight of 120 g to 150 g, were included. The left side was the experimental side, while the right side served as a control. Electrostimulating of L1-L5 ventral root was done respectively to decide the predominant nerve of quadriceps femoris. The lumbar 1 ventral root was reveal to little innervation of quadriceps femoris, and the lumbar 3 ventral root was predominant innervation. End-to-end anastomosis between the left L1 and L3 ventral root was done. After axona regeneration, the new paraspinal neural pathway of quadriceps femoris was established. At 6 months postoperatively, the early function of the new pathway was observed by electrophysiological examinations, hindlimb locomotion and BBB (basso, beattie and bresnahan)scale at 1,3,7, 14,21,28 d after SCI. Results Sixteen rats survived for 6 months after operation and only ten rats got good results because of tissue adhesion postoperatively. Single stimuli (2.5 mA,0.2 ms, 1 Hz) of the left anastomoses nerve resulted in action potential recorded from the left quadriceps femoris before and after the spinal cord hemisection horizontally between L2 segmental levels. The amplitudes of the action potentials were (7.63 ± 1.86) mV and (6.00 ± 1.92)mV, respectively, and there was no significant difference (P ＞ 0.05). The left quadriceps femoris contraction was initiated by single stimuli (2.5mA, 0.2 ms, 1 Hz) of the left anastomoses nerve. After paraplegia, when the right L3 ventral root was stimulated, the amplitude of the action potential was (15.87 ± 1.16) mV. Locomotion of the left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. According to BBB scale, there was significant difference at 1, 3, 7 d, and little difference at 14, 21, 28 d after SCI. Conclusion Spinal ventral roots cross-ananstomosis to reconstruct the paraspinal pathway of quadriceps femoris after SCI is efficient reinnervation of hindlamb muscles in a rat model and may have potential in clinical application.

Anatomia cirúrgica do nervo acessório espinhal: comoevitar lesões em procedimentos cirúrgicos no trígonocervical posterior / Surgical anatomy of the spinal accessory nerve: how to avoid injuries to the posterior cervical triangle during surgical procedures

Introdução: A síndrome resultante da lesão iatrogênica do nervo acessório espinhal (NAE) secaracteriza por dor, paralisia e escápula alada, estando relacionada a morbidade considerável. Opresente estudo investiga o grau de variação na ramificação e no curso do NAE no trígono cervicalposterior (TCP). Método: A região cervical de oito cadáveres foi dissecada bilateralmente paraexpor o NAE. A ramificação e as variações no curso do NAE no TCP foram registradas. Medidasrelacionadas a estruturas anatômicas do Músculo Esternocleidomastóideo (MEC) e do MúsculoTrapézio (MTZ) foram analisadas. Resultados: As 16 dissecções demonstraram padrão de ramificaçãodo NAE como: nenhum ramo em 25%, um ramo em 37,5% e dois ramos em 37,5%dos casos. Considerável variação foi observada na anatomia regional do NAE no TCP. Medidasrevelaram que o NAE tem relação relativamente constante com o nervo auricular magno (NAM)e esta é uma importante referência anatômica para identificação do NAE no TCP. Conclusões:O NAM é uma referência anatômica útil para a identificação do NAE no TCP. Essa abordagemsugere uma possibilidade para diminuição de lesão iatrogênica do NAE, frequentemente relacionadaà manipulação cervical de estruturas anatômicas adjacentes sem exposição direta do nervo.

Background: The resulting syndrome from iatrogenic injury to the spinal accessory nerve (SAN)is characterized by pain, paralysis and winging of the scapula are often the source of considerablemorbidity. This study analyses the degree of ramification and variations of the SAN at the posteriortriangle (PT). Method: The necks of 8 adult cadavers were dissected bilaterally to expose the SAN.The ramifications and variations of the SAN at the PT were recorded. Measurements related toanatomical landmarks of the Sternocleidomastoid Muscle (SM) and the Trapezius Muscle (TM)were analyzed. Results: The sixteen dissections performed showed the ramification pattern ofthe SAN as: no ramus in 25%, one ramus in 37.5% and 2 ramus in 37.5% of cases. Considerablevariation was seen in regional anatomy of the SAN at the PT. Measurements revealed that the SANhas a relatively constant relationship with the great auricular nerve (GAN) and this is a importantlandmark for the identification of the SAN at the PT. Conclusions: The GAN is a useful landmarkfor identification of the SAN at the PT. This approach suggests a possibility to decrease theincidence of iatrogenic injury of the SAN, that is frequently related to dissection of surroundinganatomical structures and reduced direct exposure of the nerve.

Origin and distribution of the femoral nerve in fetuses of zebu-crossed bovines

In this study the femoral nerve origin and distribution was assessed through the dissection of 30 fetuses of zebu-crossed bovines, 20 males and 10 females. These animals samples fixation in 10% formaldehyde aqueous medium occurred either by subcutaneous, intra-muscle, and intra-cavity injections in different sites, or by immersion of the mentioned pieces in vessels containing the same medium. The femoral nerve originated from the forth (L4), fifth (L5), and sixth (L6) spinal lumbar ventral branches in 14 animals (46.7%), from L4 and L5 in 13 samples (43.3%), and L5 and L6 in three cases (10%). In the course of its way, on both antimeres the mentioned nerve was branched to the greater psoas (100%), iliac (100%), pectinal (56.7%), femoral quadriceps (100%), muscles, and gave off saphena nerve, which gave branches for the pectinal (43.3%) and sartorius (100%) muscles and continued distally along the saphena artery to spread on the medial face of the knee and leg medial articulation skin. Statistically, there was no significant difference between the muscle branch frequencies given by the femoral nerve to the right and left antimeres. The obtained results related to the femoral nerve origin and distribution in fetuses of zebu-crossed bovines generally presented common characteristics with the ruminant corresponding data found in the literature, and this information is important as the basis for clinical or surgical approaches involving the studied structures.

A Case of Ancient Schwannoma Masquerading as Originating from Cervical Spinal Nerve / 대한이비인후과학회지

Schwannoma is a benign, solitary, and slow growing tumor which may arise from the nerve sheath of the peripheral, sympathetic, and cranial nerves. Ancient schwannoma is a rare variant of schwannoma with atypical tumor cells with nuclear pleomorphism and hyperchromatism. It may be confused with a malignant mesenchymal tumor or schwannoma with malignant transformation. We report a case of an ancient schwannoma being adjacent to the transverse process of the fourth cervical spine.

Contribución de fibras mielínicas provenientes de los nervios espinales lumbares L4, L5 y L6 al nervio ciático de rata adulta y sus ramas principales / Contribution of myelinated fibers from spinal L4, L5 and L6 nerves to the sciatic nerve and its main branches in the adult rat

El nervio ciático de la rata está formado por los nervios espinales (NE) lumbares L4, L5 y L6. Sin embargo, aún no se ha definido el aporte en fibras mielínicas de estos nervios espinales a lo largo del tronco nervioso. En este estudio se transectaron selectivamente los NE L4, L5 y L4-L5. Luego de una semana se disecaron los nervios ciático, tibial, sural y peroneal. Estas muestras se fijaron y procesaron para microscopía óptica y a partir de cortes coloreados con azul de toluidina se contaron las fibras mielínicas degeneradas y normales. L4 contribuyó con fibras mielínicas principalmente al nervio peroneal y L5 a los nervios ciático, tibial y sural. En general, el aporte de L6 fue menor y variable a lo largo del tronco nervioso comparado con las otras dos ramas espinales. Nuestros resultados brindan información valiosa para posteriores estudios que busquen correlacionar la contribución de los nervios espinales que componen el ciático y sus ramas principales con la función de la extremidad inferior.

The rat sciatic nerve is composed by the L4, L5 and L6 lumbar spinal nerves. However, the contribution in myelinated fibers originating from these nerves along this nervous trunk has not yet been defined. In the present study, the L4, L5 and L4-L5 spinal nerves were selectively transected. After one week the sciatic, tibial, sural and peroneal nerves were dissected. These samples were fixed and processed for optical microscopy, and both degenerated and normal myelinated fibers were counted in toluidine blue-stained semi-thin sections. L4 contributed with myelinated fibers mainly to the peroneal nerve, and L5 to the sciatic, tibial and sural nerves. In general, the contribution of L6 was smaller and variable along the nervous trunk in comparison to the other two spinal branches. Our results give key information for further studies looking to correlate the contribution of spinal nerves making part of the sciatic nerve and its main branches with hind limb function.

The diagnosis and surgical treatment of sacral fracture (Denis Ⅱ fracture) with sacral neurological damage / 中华骨科杂志

5 mm. Oblique coronal MR of secrum could show the full length of sacral never. There were some primiral espression of MR of sacral neurological dam-age -- the variation of sacral never canal, the fatty disappearance of peri-never, the route alteration of never. 14 patients were followed up from 6 to 12 months with an average of 7.1 months. According to the BMRC score system the excellent result was obtained in 9 cases, good in 1 case, no change in 1 case. Con-clusion Clinic history and neurological examination associated with X-ray, CT and MRI was the important of the diagnosis of sacral neurological damage, the new surgical approach may be a ideal approach to treat sacral neurological damage in the sacral nerve canal region.

An anatomical and clinical study of modified anterior approach in management of thoracolumbar injury / 中华骨科杂志

Objective To observe the morphology of thoracolumbar spinal nerve roots and their surrounding structures, in order to find out their anatomical relationship and to improve surgical procedures as well as to reduce the operative injury and complications. Methods 16 adult cadavers were studied anatomically. The diameters of spinal nerve roots from T10 to L3 at the outlet of intervertebral foramen, the percentages of the distance from spinal nerve roots to the upper border of corresponding vertebral bodies in vertebral height, the angles between spinal nerve roots with lateral border of vertebrae were measured and analyzed. The surgical incision and procedure for the treatment of thoracolumbar fracture were designed and applied in 58 patients of thoracolumbar injury. Results The diameters of spinal nerve roots increased gradually from T10 to L3 in the intervertebral foramen. The percentages of the distance from spinal nerve roots to the upper border of vertebrae in vertebral height gradually became larger too. The angles between spinal nerve roots with vertebral bodies diminished gradually. Around intervertebral foramen, the pattern of spinal nerves and blood vessels was arranged in order as vein, nerve and artery from above down below. The nerves and vessels extended out of the intervertebral foramen together. In clinical practice, 58 cases of thoracolumbar injury were surgically treated with traditional anterior approach and "renal" incision in 35 cases, and with modified anterior approach in "┑" shape in 23 cases. Prior to the modification of surgical techniques, the mean amount of blood loss was 670 ml, the mean operation time was 199 min; however, by the modification of surgical procedures, the mean amount of blood loss decreased to 435 ml, and the mean operation time reduced to 137 min. In an average follow-up of 9 months, the spine recovered to normal curvature and alignment in all cases; the fusion rate was 100%; no failure of implant occurred; neurological function was improved at least one grade in 94.5%. Conclusion Modified anterior approach is helpful to reduce operative injuries and complications. It makes surgical manipulation feasible comparing to the traditional approach.

A Study on Scoliosis Induced by Resection of Thoracic Spinal Nerves / 대한정형외과학회잡지

Msny clinical and experimental studies trying to elucidate the cause of idiopathic scoliosis have been carried out. There, however, is no established theory to explain it. This paper is aimed at approaching one of various causes of idiopathic scoliosis by producing thoracic scoliosis in growing rabbits with unilateral resection of thoracic spinal nerves. All 43 rabbits were divided into four different groups. The first group(11 rabbits) consisted of rsbbits whose primary anterior and posterior divisions of the unilateral thoracic spinal nerves were resected. The second(11 rabbits) and the third(11 rabbits) were groups of rabbits whose primary anterior and posterior devisions were resected respectively. The fourth(10 rabbits) was the control group. The first group of rsbbits showed the most prominent curvature of the spine. The group of resection of primary posterior division showed less severe scoliosis than the first group but more marked scoliosis than the group of resection of primary anterior division. The biopsy of the denervated muscles included in the scoliosis revealed atrophy. It is concluded from the animal experiments with 43 growing rabbits that unilateral paralysis of the thoracic spinal nerves could be one csuse of iniopathic scoliosis and the primary posterior division of the thoracic spinal nerve contributed to the production of scoliosis more than the primary anterior division.