De- and remyelination in spinal roots during normal perinatal development in the cat: a brief summary of structural observations and a conceptual hypothesis.

We have studied the perinatal development of large myelinated axons (adult D > 10 microm) in cat ventral and dorsal lumbosacral spinal roots using autoradiography and electron microscopy (serial section analysis). These axons acquire their first myelin sheaths 2-3 weeks before birth and show nearly mature functional properties first at a diameter of 4-5 microm, i.e. 3-4 weeks after birth. The most conspicuous event during this development takes place around birth, when a transient primary myelin sheath degeneration strikes already well myelinated although short 'aberrant' Schwann cells. The aberrant Schwann cells become completely demyelinated, then measuring about 10 microm in length, and are subsequently eliminated from their parent axons. Morphometry indicates that on average 50% of the Schwann cells originally present along a prospective large spinal root axon suffer elimination. Here it should be noted that in cat lumbo-sacral spinal roots, the longitudinal growth of myelinated Schwann cells that belong to the group containing what will be the largest fibers is on average twice that of their parent axons. The elimination phenomenon is particularly striking in the dorsal roots close to the spinal cord where CNS tissue invades the root for several hundred micrometres. Our observations suggest that, once demyelinated and then eliminated, Schwann cells (i.e. aberrant Schwann cells) colonize neighbouring axons, future myelinated as well as future unmyelinated ones. In the former case the immigrant Schwann cells appear to start myelin production, possibly risking a second demyelination and elimination. We take our observations to indicate that Schwann cells in the cat, during normal development, may switch iteratively between a 'myelin-producing' and a 'non-myelin-producing' phenotype. From a functional point of view the transient presence along a myelinated axon of intercalated unmyelinated segments approximately 10 microm long, due to aberrant Schwann cells, would mean a slowing down of the action potential. The rapid disappearance of aberrant Schwann cells during the two first postnatal weeks could then explain the progressing normalization of the leg-length conduction time.

Spinal cord implantation of avulsed ventral roots in primates; correlation between restored motor function and morphology.

Functional restitution following spinal cord implantation of avulsed ventral roots was assessed electromyographically and correlated with the morphology of the regenerated neural structures in primates. The C5-C8 ventral roots were avulsed from the spinal cord in seven Macaca fascicularis monkeys. In three animals the roots were immediately reimplanted into the ventrolateral part of the spinal cord. In two monkeys the avulsed roots were reimplanted with a delay of 2 months and in two control animals the roots were not reimplanted. There was substantial recovery of function after both immediate and delayed spinal cord implantation of the avulsed ventral roots. The population of neurons that had regenerated was larger than on the control side, indicating a rescue of cells after an immediate root implantation. Different functional types of neurons had been attracted to regrow axons to the implanted root as judged by their position in the ventral horn. Thus, neurons normally supplying antagonistic muscles, such as the triceps muscle, participated in the innervation of the biceps muscle. Functionally this deficient directional specificity was correlated to both spasticity and co-contractions among agonistic and antagonistic muscles. Occasional electromyographic signs of function occurred also in control animals where the avulsed roots had not been implanted. This recovery was found to depend on regrowth from the site of avulsion, within the pia mater among the leptomeningeal cells and to the avulsed roots. The acceptable functional dexterity regained due to corrective surgery is discussed in terms of neurotrophism and plasticity.

Redistribution of Schwann cells at the developing PNS-CNS borderline. An ultrastructural and autoradiographic study on the S1 dorsal root of the cat.

In order to test our hypothesis that myelin-forming Schwann cells early during development, after having been eliminated from their parent axons, colonize neighbouring unmyelinated axons, we studied the distribution of Schwann cells at the PNS-CNS border in the feline S1 dorsal spinal root during pre- and postnatal development using electron microscopy and autoradiography. Myelination of axons peripheral to the PNS-CNS border began about 1.5 weeks before birth. The adult distribution of one-third myelinated and two-thirds unmyelinated axons was noted 3 weeks after birth. Analysis based on to-scale reconstructions of axon and Schwann cell samples from the first 6 postnatal weeks gave the following results. (1) CNS tissue appeared in the proximal part of the root around birth and expanded peripherally during the first three postnatal weeks. (2) The number of Schwann cells associated with myelinated axons decreased. (3) The number of Schwann cells associated with unmyelinated axons increased. (4) The mitotic activity of the Schwann cells was low at birth and nil after the first postnatal weak. (5) Apoptotic cell units were virtually absent. (6) Aberrant Schwann cells, i.e. short and very short Schwann cells with distorted and degenerating myelin sheaths, were common. (7) The endoneurial space contained numerous Schwannoid cells i.e. solitary cells surrounded by a basal lamina. (8) Cytoplasmic contacts between unmyelinated axons and aberrant Schwann cells or Schwannoid cells were observed. We take these results to support our hypothesis.

Axonal constriction at Ranvier's node increases during development.

We have studied the ratio between the nodal and the internodal diameter (the dn/d(in) ratio) of large myelinated axons in the L7 ventral spinal root of the cat during pre- and postnatal development using light and electron microscopy. A substantial nodal constriction, dn/d(in) = 0.6, was found at the beginning of myelination, about 2 weeks before birth. The ratio decreased during the subsequent 10 weeks and approached the adult value of 0.47 (SE 0.01, N = 45) in the 8 weeks old kitten. The observations are discussed with respect to the maturation of the nodal region and to our earlier idea that the constricted nodal axon segments of large peripheral myelinated nerve fibres of adult cats and kittens 2 months and more of age are sites capable of interacting with and perhaps even controlling the passage of axonally transported materials.

Functional recovery in primates with brachial plexus injury after spinal cord implantation of avulsed ventral roots.

Intraspinal replantation of avulsed spinal nerve roots as a surgical treatment for motor deficits after severe brachial plexus injury was investigated in primates. Under general anaesthesia hemi-laminectomy was performed in cynomolgus monkeys (Macaca fascicularis). Ventral roots within the brachial plexus were then avulsed by traction and subsequently implanted into the ventrolateral aspect of the spinal cord. No dysfunction in the long fibre tracts was seen following surgery. Postoperatively there was a flaccid paralysis of the arm on the lesioned side. Severe atrophy developed within 5-7 weeks in the muscles supplied by the avulsed roots and EMG revealed denervation activity. Two to three months after surgery there were EMG signs of reinnervation, which were shortly followed by evidence of clinical recovery. A gradual improvement in the function of the affected arm occurred and the animals' motor behaviour normalised. One year after surgery there was a full range of motion in the arm, but the EMG activity in the reinnervated muscles at maximal force was reduced. Tracing of regenerated motor neurons with horseradish peroxidase (HRP) injected into the biceps muscle revealed retrogradely labelled motor neurons confined to the ipsilateral ventral horn. It was concluded that intraspinal replantation of avulsed ventral roots in primates significantly promotes motor recovery in the muscles supplied by the lesioned spinal cord segments.

Novel surgical strategies to correct neural deficits following experimental spinal nerve root lesions.

In attempts to correct neural deficits following avulsion trauma, novel experimental strategies were developed. In rats, spinal roots were replanted superficially in the dorsal horn following dorsal root avulsion and concomitant denervation by ganglionectomy. Outgrowth from cord neurons in the dorsal horn into the implanted dorsal root was demonstrated by means of retrograde HRP labeling. Double labeling experiments showed that some of these neurons had retained their central projections while extending new processes into the implanted root. After dorsal root avulsion, sensory pathways might be reconstructed by substituting the lost input from damaged primary sensory neurons with induced peripheral outgrowths from secondary neurons. In primates, intraspinal replantation of avulsed ventral nerve roots was investigated as a surgical treatment for motor deficits that develop after severe brachial plexus injury. Two to 3 months after surgery there were EMG signs of reinnervation in previously denervated muscles, which were shortly followed by evidence of clinical recovery. A gradual improvement in the function of the affected arm occurred and motor behavior became normalized, although the EMG activity in the reinnervated muscles at maximal contraction was still reduced. The outcome of these experimental studies indicates that reconstructive surgery applied to the brachial plexus might be of value to restore functional deficits induced by traumatic spinal nerve root avulsions also in man.