Objective: This study aims to evaluate the safety and efficacy of PETD combined with nerve root water imaging of MRI for the treatment of lumbar disc herniation. Methods: A retrospective review was performed on 62 pat...Objective: This study aims to evaluate the safety and efficacy of PETD combined with nerve root water imaging of MRI for the treatment of lumbar disc herniation. Methods: A retrospective review was performed on 62 patients with lumbar disc herniation from March 2019 to March 2021. The study included an experimental group of 30 patients and a control group of 32 patients. The experimental group underwent PETD combined with nerve root water imaging of MRI, while the control group received traditional PETD treatment. The visual analogue scoring method (VAS score), and JOA lumbar spine function score before and after surgery were compared between the two groups, and efficacy was assessed and compared using the MacNab score. Results: The mean operation time was significantly reduced in the experimental group (56.43 ±10.40 minutes) compared to the control group (65.69 ±14.12 minutes). The VAS score was compared between the two groups with preoperative (p = 0.624), one month after surgery (p = 0.325), three months after surgery (p = 0.676), one year after surgery (p = 0.341);The JOA score was compared between the two groups with preoperative (p = 0.961), one month after the surgery (p = 0.266), three months after surgery (p = 0.185), one year after surgery (p = 0.870), they were no significant statistical difference;The efficacy evaluation of the last follow-up Macnab showed that all the 30 patients in the experimental group were excellent, 31 of 32 patients in the control group were excellent, 1 case was good;There was no statistical difference in the comparison between the two groups (p > 0.05). Conclusion: The study concludes that the combined approach of PETD with nerve root water imaging of MRI is a safe, effective, and more efficient alternative to conventional PETD for treating lumbar disc herniation.展开更多
The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root(VR)to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis.Six formalin-fixed(thre...The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root(VR)to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis.Six formalin-fixed(three males and three females)cadavers were used.The VR of the contralateral S1 was transferred to the VR of the ipsilateral L5.The sural nerve was selected as a bridge between the donor and recipient nerve.The number of axons,the cross-sectional areas and the pertinent distances between the donor and recipient nerves were measured.The extradural S1 VR and L5 VR could be separated based on anatomical markers of the dorsal root ganglion.The gross distance between the S1 nerve root and L5 nerve root was 31.31(±3.23)mm in the six cadavers,while that on the diffusion tensor imaging was 47.51(±3.23)mm in 60 patients without spinal diseases,and both distances were seperately greater than that between the outlet of S1 from the spinal cord and the ganglion.The numbers of axons in the S1 VRs and L5 VRs were 13414.20(±2890.30)and 10613.20(±2135.58),respectively.The cross-sectional areas of the S1 VR and L5 VR were 1.68(±0.26)mm2 and 1.08(±0.26)mm2,respectively.In conclusion,transfer of the contralateral S1 VR to the ipsilateral L5 VR may be an anatomically feasible treatment option for unilateral spastic lower limb paralysis.展开更多
BACKGROUND：It has been shown that interleukin-1 （IL-1） may cause inflammatory reactions, which stimulate the nerve root of patients with lumbar intervertebral disc protrusion and leads to pain. Whether the clinical...BACKGROUND：It has been shown that interleukin-1 （IL-1） may cause inflammatory reactions, which stimulate the nerve root of patients with lumbar intervertebral disc protrusion and leads to pain. Whether the clinical curative effects of acupuncture in the treatment of lumbar and leg pain are linked to an inhibition of local IL-1 secretion is unknown. OBJECTIVE： To assess the influence of acupuncture on IL-1, this study was designed to verify the effects of acupuncture at the ＂Huatuojiaji （Extra）＂ point on the nerve root in a rat model of lumbar nerve root compression, compared with administration of meloxicam, a non-steroidal anti-inflammatory drug. DESIGN, TIME AND SETTING： Randomized, controlled, molecular biology experiment, performed at the Experimental Center, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between September 2005 and April 2006. MATERIALS： Forty healthy adult Sprague Dawley rats of either gender were included in this study. The rats were randomly and evenly divided into the following four groups： normal control, model, acupuncture and meloxicam groups. Lumbar nerve root compression was induced in rats in the model, acupuncture, and meloxicam groups by inserting a specially made silicon rubber slice at the juncture of the L5 nerve root and the dural sac. The acupuncture needle （pattern number N3030, 30#, 1.5 inch） was purchased from Suzhou Medical Appliance Factory, China. IL-1 enzyme linked immunosorbent assay （ELISA） kit was purchased from Santa Cruz Biotechnology, Inc., USA. METHODS： The acupuncture group was acupunctured at the ＂Huatuojiaji＂ point, which is lateral to the compressed L5-6 nerve root, with an acupuncture depth of 0.5 cm. There were two treatment courses, each of involved seven 20-minute acupuncture sessions, one session a day. The meloxicam group was administered intragastrically 3.75 mg/kg meloxicam （5 mg meloxicam /10 mL physiological saline）. Rats in the normal control group and model group received an intragastric administration of 10 mL/kg physiological saline. All administrations were performed once a day. MAIN OUTCOME MEASURES： At day 14 post-surgery, the IL-1 level in the compressed nerve root was determined by a streptavidin-peroxidase （S-P） immunohistochemical method, and IL-1β mRNA expression in the compressed nerve root was simultaneously detected by real-time reverse transcription-polymerase chain reaction. RESULTS： The expression levels of IL-1 and IL-1β mRNA in the L5 nerve root were significantly higher in the model group than in the control group （P 〈 0.01）. However, the expression levels of IL-1 and IL-1β mRNA were significantly lower in the acupuncture and meloxicam groups than in the model group （P 〈 0.05–0.01）. Expression levels of IL-1 and IL-1β mRNA were significantly higher in the acupuncture group than in the meloxicam group （P 〈 0.01）. CONCLUSION： Acupuncture at the ＂Huatuojiaji＂ point decreases the IL-1 level by inhibiting IL-1β mRNA expression to a greater extent than meloxicam administration.展开更多
Current animal models of nerve root compression due to lumbar disc herniation only assess the mechanical compression of nerve roots and the inflammatory response. Moreover, the pressure applied in these models is stat...Current animal models of nerve root compression due to lumbar disc herniation only assess the mechanical compression of nerve roots and the inflammatory response. Moreover, the pressure applied in these models is static, meaning that the nerve root cannot be dynamically compressed. This is very different from the pathogenesis of lumbar disc herniation. In this study, a chitosan/polyacrylamide double-network hydrogel was prepared by a simple two-step method. The swelling ratio of the double-network hydrogel increased with prolonged time, reaching 140. The compressive strength and compressive modulus of the hydrogel reached 53.6 and 0.34 MPa, respectively. Scanning electron microscopy revealed the hydrogel's crosslinked structure with many interconnecting pores. An MTT assay demonstrated that the number of viable cells in contact with the hydrogel extracts did not significantly change relative to the control surface. Thus, the hydrogel had good biocompatibility. Finally, the double-network hydrogel was used to compress the L4 nerve root of male sand rats to simulate lumbar disc herniation nerve root compression. The hydrogel remained in its original position after compression, and swelled with increasing time. Edema appeared around the nerve root and disappeared 3 weeks after operation. This chitosan/polyacrylamide double-network hydrogel has potential as a new implant material for animal models of lumbar nerve root compression. All animal experiments were approved by the Animal Ethics Committee of Neurosurgical Institute of Beijing, Capital Medical University, China(approval No. 201601006) on July 29, 2016.展开更多
BACKGROUND： Varying degrees of inflammatory responses occur during lumbar nerve root compression. Studies have shown that nitric oxide synthase （NOS） and calcitonin gene-related peptide （CGRP） are involved in sec...BACKGROUND： Varying degrees of inflammatory responses occur during lumbar nerve root compression. Studies have shown that nitric oxide synthase （NOS） and calcitonin gene-related peptide （CGRP） are involved in secondary disc inflammation. OBJECTIVE： To observe the effects of warm acupuncture on the ultrastructure of inflammatory mediators in a rat model of lumbar nerve root compression, including NOS and CGRP contents. DESIGN, TIME AND SETTING： Randomized, controlled study, with molecular biological analysis, was performed at the Experimental Center, Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University, between September 2006 and April 2007. MATERIALS： Acupuncture needles and refined Moxa grains were purchased from Shanghai Taicheng Technology Development Co., Ltd., China; Mobic tablets were purchased from Shanghai Boehringer Ingelheim Pharmaceuticals Co., Ltd., China; enzyme linked immunosorbent assay （ELISA） kits for NOS and CGRP were purchased from ADL Biotechnology, Inc., USA. METHODS： A total of 50, healthy, adult Sprague-Dawley rats, were randomly divided into five groups normal, model, warm acupuncture, acupuncture, and drug, with 10 rats in each group. Rats in the four groups, excluding the normal group, were used to establish models of lumbar nerve root compression. After 3 days, Jiaji points were set using reinforcing-reducing manipulation in the warm acupuncture group. Moxa grains were burned on each needle, with 2 grains each daily. The acupuncture group was the same as the warm acupuncture group, with the exception of non-moxibustion. Mobic suspension （3.75 mg/kg） was used in the oral drug group, once a day. Treatment of each group lasted for 14 consecutive days. Modeling and medication were not performed in the normal group. MAIN OUTCOME MEASURES： The ultrastructure of damaged nerve roots was observed with transmission electron microscopy; NOS and CGRP contents were measured using ELISA. RESULTS： The changes of the radicular ultramicrostructure were characterized by Wallerian degeneration; nerve fibers were clearly demyelinated; axons collapsed or degenerated; outer Schwann cell cytoplasm was swollen and its nucleus was compacted. Compared with the normal group, NOS and CGRP contents in the nerve root compression zone in the model group were significantly increased （P 〈 0.01）. Nerve root edema was improved in the drug, acupuncture and the warm acupuncture groups over the model group. NOS and CGRP expressions were also decreased with the warm acupuncture group having the lowest concentration （P 〈 0.01）. CONCLUSION： In comparison to the known effects of Mobic drug and acupuncture treatments, the warm acupuncture significantly decreased NOS and CGRP expression which helped improve the ultrastructure of the compressed nerve root.展开更多
There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior...There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve roots.Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule.The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs.We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage.In a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over time.At 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic side.At 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots.In addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord.Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved.These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal ankle.Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage.All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.IACUC-1906009)in June 2019.展开更多
Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging（T1WI） and T2-weighted imaging（T2WI） scans are commonly used to image spinal cord degeneration. H...Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging（T1WI） and T2-weighted imaging（T2WI） scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging（DTI） for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2 WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1 WI and T2 WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots（49%） and abruption in 17 lumbosacral spinal nerve roots（23%）. Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.展开更多
If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show goo...If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root ＋ posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root ＋ posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root ＋ posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root ＋ posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve.展开更多
Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode b...Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re- mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9_10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu- lation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.展开更多
Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng＇s Spinal Manipulation, hot fomentation, and bed rest （treatment group）. The remaining...Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng＇s Spinal Manipulation, hot fomentation, and bed rest （treatment group）. The remaining 46 patients were treated with hot fomentation and bed rest only （control group）. After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng＇s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.展开更多
BACKGROUND Redundant nerve roots(RNRs)of the cauda equina are often a natural evolutionary part of lumbar spinal canal stenosis secondary to degenerative processes characterized by elongated,enlarged,and tortuous nerv...BACKGROUND Redundant nerve roots(RNRs)of the cauda equina are often a natural evolutionary part of lumbar spinal canal stenosis secondary to degenerative processes characterized by elongated,enlarged,and tortuous nerve roots in the superior and/or inferior of the stenotic segment.Although magnetic resonance imaging(MRI)findings have been defined more frequently in recent years,this condition has been relatively under-recognized in radiological practice.In this study,lumbar MRI findings of RNRs of the cauda equina were evaluated in spinal stenosis patients.AIM To evaluate RNRs of the cauda equina in spinal stenosis patients.METHODS One-hundred and thirty-one patients who underwent lumbar MRI and were found to have spinal stenosis between March 2010 and February 2019 were included in the study.On axial T2-weighted images(T2WI),the cross-sectional area(CSA)of the dural sac was measured at L2-3,L3-4,L4-5,and L5-S1 levels in the axial plane.CSA levels below 100 mm^2 were considered stenosis.Elongation,expansion,and tortuosity in cauda equina fibers in the superior and/or inferior of the stenotic segment were evaluated as RNRs.The patients were divided into two groups:Those with RNRs and those without RNRs.The CSA cut-off value resulting in RNRs of cauda equina was calculated.Relative length(RL)of RNRs was calculated by dividing the length of RNRs at mid-sagittal T2WI by the height of the vertebral body superior to the stenosis level.The associations of CSA leading to RNRs with RL,disc herniation type,and spondylolisthesis were evaluated.RESULTS Fifty-five patients(42%)with spinal stenosis had RNRs of the cauda equina.The average CSA was 40.99±12.76 mm^2 in patients with RNRs of the cauda equina and 66.83±19.32 mm^2 in patients without RNRs.A significant difference was found between the two groups for CSA values(P<0.001).Using a cut-off value of 55.22 mm^2 for RNRs of the cauda equina,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)values of 96.4%,96.1%,89.4%,and 98.7%were obtained,respectively.RL was 3.39±1.31(range:0.93-6.01).When the extension of RNRs into the superior and/or inferior of the spinal canal stenosis level was evaluated,it was superior in 54.5%,both superior and inferior in 32.8%,and inferior in 12.7%.At stenosis levels leading to RNRs of the cauda equina,29 disc herniations with soft margins and 26 with sharp margins were detected.Disc herniation type and spondylolisthesis had no significant relationship with RL or CSA of the dural sac with stenotic levels(P>0.05).As the CSA of the dural sac decreased,the incidence of RNRs observed at the superior of the stenosis level increased(P<0.001).CONCLUSION RNRs of the cauda equina are frequently observed in patients with spinal stenosis.When the CSA of the dural sac is<55 mm^2,lumbar MRIs should be carefully examined for this condition.展开更多
BACKGROUND： Computed Tomography （CT） and Magnetic Resonance Imaging （MRI） can display the site of lumbar spinal stenosis and predict nervous compression at the morphological level; however, pure morphological cha...BACKGROUND： Computed Tomography （CT） and Magnetic Resonance Imaging （MRI） can display the site of lumbar spinal stenosis and predict nervous compression at the morphological level; however, pure morphological changes cannot reflect functional alterations in a compressed nerve root. Dermatomal somatosensory evoked potential （DSEP） provides a means to assess the functional state of a nerve root. OBJECTIVE： To evaluate the clinical significance of DSEP, assessing the degree of nerve root injury following lumbar spinal stenosis. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Orthopaedic Surgery, Hainan People＇s Hospital, China, between September 2004 and December 2007. PARTICIPANTS： Forty-seven patients diagnosed with lumbar spinal stenosis by CT or MRI were selected as the case group; fifty healthy subjects were collected as the control group. METHODS： A KEYPOINT myoelectric evoked potential apparatus （DANTEC Company, Denmark） was used to measure DSEP, and stimulative spots were determined in accordance with the skin key sensory spot standards established by The American Spinal Injury Association： L4 in the medial malleolus, L5 in the third metatarsophalangeal joint of the dorsum of foot and S1 in the lateral heel. The needle electrode used as the recording electrode was located at the Cz point of the cranium, and the reference electrode at the Fz point. MAIN OUTCOME MEASURES： Latency of the P40 peak of DSEP, P1-N1 amplitude, P40 waveform and differentiation and disappearance of various waves. RESULTS： The sensitivity and diagnostic concurrence with surgery of nerve root injury following lumbar spinal stenosis evaluated by DSEP was 95.7 %. P40 latencies at L4, L5 and S1 in the case group were significantly longer than in the control group （P 〈 0.05）, and the P1-N1 amplitude in the case group was significantly lower than the control group （P 〈 0.05-0.01）. Nerve root injury was categorized according to DSEP latency as follows： severe damage （disappearance of the P40 wave in 103 dermatomes）, moderate damage （prolongation of the P40 peak latency ≥ 3.0 times the standard deviation of the normal mean in 60 dermatomes） and mild damage （prolongation of the P40 peak latency ≥ 2.5 times the standard deviation of the normal mean in 31 dermatomes）. CONCLUSION： DSEP can be used to determine the severity of nerve root injury following lumbar spinal stenosis with high sensitivity and specificity.展开更多
BACKGROUND： It has been reported that dermatomal somatosensory evoked potential （DSEP） can be used for diagnosing nerve root injury in patients with lumbar disc herniation （LDH）, and that 83% 95% of patients suff...BACKGROUND： It has been reported that dermatomal somatosensory evoked potential （DSEP） can be used for diagnosing nerve root injury in patients with lumbar disc herniation （LDH）, and that 83% 95% of patients suffer from the disease. Body height correction is not performed prior to determinations of latency and latency difference between the healthy and affected sides. However, latency noticeably correlates to body height. OBJECTIVE： This study aims to determine the lumbosacral nerve root injury in patients with LDH by DSEP, and to evaluate the sensitivity of the DSEP difference between the healthy and affected sides using a diagnostic index following body height correction. DESIGN： A case-control observation. SETTING： Department of Orthopedic Surgery, Hainan Provincial People＇s Hospital. PARTICIPANTS： Ninety-six patients, comprised of 67 males and 29 females, with an average age of 43 years and a mean body height of 1.65 m （range 1.48-1.81 m）, were recruited for this study. These patients suffered from unilateral lower limb radiation pain and received treatment at the Department of Orthopedic Surgery, Hainan Provincial People＇s Hospital between January 2004 and December 2006. All patients were confirmed to suffer from LDH at the L3-4, L-5, and/or Ls-SI by CT and/or MRI examinations. Central nervous system diseases were excluded. In order to obtain a normal reference value, DSEP was determined for a group of 50 subjects, who concurrently received health examinations in the same department. The subjects had no previous history of back leg pain or nervous system disease. The group of healthy controls included 26 males and 24 females, with an average age of 37 years and a mean body height of 1.63 m （range 1.50-1.80 m）. Written informed consent was obtained from all subjects for laboratory samples. The protocol was approved by the Hospital＇s Ethics Committees. DSEP was determined with myoelectricity-evoked potential equipment （Keypoint, Batch No. 9020A0042591, Dantec Company, Denmark）. METHODS： DSEP of patients with LDH was determined. Constant-voltage square pulse stimulation was used to determine DSEP, with the following parameters： a pulse wave width of 0.2 milliseconds; a saddle-like stimulating electrode; a stimulation intensity 3 times greater than the sensation threshold; a stimulation frequency of 1.5 Hz; mean superposition greater than 100 times; and inter-electrode impedance 〈 5 k Q. The stimulation point was a skin key sensation point confirmed by the American Spinal Injury Association, i.e. L4 at medial malleolus, L5 at the third metatarsophalangeal joint on the dorsum of the foot, and SI at the lateral heel. The recording electrode was a needle electrode, the recording point was Cz, and the reference electrode was Fz. DSEP latency of P40, and latency differences of P40, between the healthy side and the affected side, were determined. DSEP at L4, L5, and S1 nerve roots of the lower limbs of 50 healthy controls were bilaterally determined. The normal values of P40 latency and P40 N50 amplitude were statistically obtained. MAIN OUTCOME MEASURES： Determination of DSEP values. RESULTS： Ninety-six patients with LDH and fifty healthy controls participated in the final analysis. In the healthy controls, the amplitude of DSEP varied greatly, with a mean amplitude co-efficient of variation of 58% for L4, L5, and SI dermatomes. P40 latency was stable, with a mean latency coefficient of variation of 4.7%. In patients with LDH, the P40 wave disappeared. P40 latency was 2.5 times prolonged compared to normal mean value. P40 latency difference between the healthy and the affected side was 2.5 times higher than the normal mean value of the healthy side. CONCLUSION： DSEP can reflect the functional status of lumbosacral nerve root. P40 latency difference between the healthy side and the affected side is the most sensitive diagnosis index for patients with LDH suffering from unilateral lower limb radiation pain.展开更多
Most studies on peripheral nerve injury have focused on repair at the site of injury, but very few have examined the effects of repair strategies on the more proximal neuronal cell bodies. In this study, an approximat...Most studies on peripheral nerve injury have focused on repair at the site of injury, but very few have examined the effects of repair strategies on the more proximal neuronal cell bodies. In this study, an approximately 10-mm-long nerve segment from the ischial tuberosity in the rat was transected and its proximal and distal ends were inverted and sutured. The spinal cord was subjected to pulsed electrical stimulation at T10 and L3, at a current of 6.5 m A and a stimulation frequency of 15 Hz, 15 minutes per session, twice a day for 56 days. After pulsed electrical stimulation, the number of neurons in the dorsal root ganglion and anterior horn was increased in rats with sciatic nerve injury. The number of myelinated nerve fibers was increased in the sciatic nerve. The ultrastructure of neurons in the dorsal root ganglion and spinal cord was noticeably improved. Conduction velocity of the sciatic nerve was also increased. These results show that pulsed electrical stimulation protects sensory neurons in the dorsal root ganglia as well as motor neurons in the anterior horn of the spinal cord after peripheral nerve injury, and that it promotes the regeneration of peripheral nerve fibers.展开更多
BACKGROUND Primary melanomas affecting the central nervous system are very rare,and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer.As a consequence,not much is known about ...BACKGROUND Primary melanomas affecting the central nervous system are very rare,and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer.As a consequence,not much is known about this.CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root.A 64-year-old woman presented with symptoms of numbness in the right side of the neck,pain,and hypoesthesia in the right upper limb which persisted for 1 year.Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4.Magnetic resonance imaging examination revealed a mass(approximately 2.5 cm×1.4 cm×1 cm)in the right side of the spinal canal in the C-2 plane.Based on findings obtained during operation,perioperative examination,pathological diagnosis,and the diagnostic criteria of primary central melanoma proposed by Hayward,the mass was confirmed to be a melanoma of intraspinal nerve root origin.CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal.The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours.Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.展开更多
Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular ...Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.展开更多
In a previous study, heat shock protein 27 was persistently upregulated in ventral motor neurons following nerve root avulsion or crush. Here, we examined whether the upregulation of heat shock protein 27 would increa...In a previous study, heat shock protein 27 was persistently upregulated in ventral motor neurons following nerve root avulsion or crush. Here, we examined whether the upregulation of heat shock protein 27 would increase the survival rate of motor neurons. Rats were divided into two groups： an avulsion-only group （avtflsion of the L4 lumbar nerve root only） and a crush-avulsion group （the L4 lumbar nerve root was crushed 1 week prior to the avulsion）. Immunofluores- cent staining revealed that the survival rate of motor neurons was significantly greater in the crush-avulsion group than in the avulsion-only group, and this difference remained for at least 5 weeks after avulsion. The higher neuronal survival rate may be explained by the upregulation of heat shock protein 27 expression in motor neurons in the crush-avulsion group. Further- more, preconditioning crush greatly attenuated the expression of nitric oxide synthase in the motor neurons. Our findings indicate that the neuroprotective action of preconditioning crush is mediated through the upregulation of heat shock protein 27 expression and the attenuation of neuronal nitric oxide synthase upregulation following avulsion.展开更多
BACKGROUND： Nerve root avulsion is a frequent finding in patients with brachial plexus injury following road traffic accidents or as a result of severe arm traction during complicated deliveries. This injury constitu...BACKGROUND： Nerve root avulsion is a frequent finding in patients with brachial plexus injury following road traffic accidents or as a result of severe arm traction during complicated deliveries. This injury constitutes a challenging clinical and surgical problem. The morphological characteristics of motoneurons after nerve root avulsion deserve further analysis. OBJECTIVE： To study the different morphological changes of α-motoneurons under light and electron microscopy after C8 spinal ventral rootlets avulsion and transection at various stages. DESIGN： Controlled animal study. SETTING： Department of Anatomy, King Faisal University. MATERIALS： The experiment was carried out at the Department of Anatomy, College of Medicine, King Faisal University between January 2005 and March 2006. Six adult Sprague Dawley rats weighing 200-350 g, irrespective of gender, were used for this study. The animals were bred at the animal house, College of Medicine, King Faisal University, and fed on rat maintenance diet. Water and standard diet were supplied ad libitum. Animal interventions were carried out according to animal ethical standards. METHODS： Three animals were randomly chosen for avulsion of the right ventral rootlets of C8 spinal nerves. The other three received transection of the right ventral rootlets of C8 spinal nerves. ①Avulsion experiment： After rats were anesthetized, the right ventral rootlets of C8 spinal nerves were identified. The ventral rootlets were avulsed from the spinal cord by traction with a fine hook （Fine Science Tools Inc., No. 10031-13, Germany）. Traction was exerted in a direction parallel to the course of the spinal root. Under the operating microscope, the C8 segment was exactly located. After checking the successfulness of the surgical procedure, the C8 segment was separated from the spinal cord. The outcome of the avulsion procedure was as follows： two animals had true avulsion, i.e., no remaining stump was attached to the spinal cord surface. One rat had a stump still attached. The animal was sacrificed I week later and was included in the transaction experiment for analysis. ②Transection experiment： Using fine scissors, the ventral rootlets were transected close to the area of the right ventral rootlets junction with the dorsal rootlets. MAIN OUTCOME MEASURES： After the rats were anesthetized, C8 spinal cord segments were collected for the avulsion experiment from 2 rats, 1 rat, and I rat at weeks 1, 4, and 8, respectively, and from 1 rat each after 4 and 8 weeks in the transection experiment. The morphology of α -motoneurons was observed under light microscopic and electron microscopic examination. RESULTS： All six rats were included in the final analysis. ①Avulsion experiment： α-motoneurons of the C8 spinal segment were found to survive avulsion injury up to 4 weeks. Thereafter, signs of degeneration occurred in a gradual process, involving first the most anterior motoneurons and probably proceeding posterior in a zonal pattern. A clear reduction in motoneuron size was noted. The largest cell body detected was smaller than the control. Nuclei were rounded and central. Nissl substance appeared granular and was dispersed over the cytoplasm, and the α -motoneurons were of normal electron density. At 8 weeks, three zones were observed in the ventral horn. The anterior zone was the most affected and showed intensely basophilic shrunken motoneurons. Nearly all nuclei were centrally located, but were irregular in outline. ②Transection experiment： one week after ventral root transection, nuclei were slightly eccentric and irregular in outline, but of normal size. Nucleolar vacuolation was observed in several neurons, and the ultrastructure of the chromatolytic Nissl bodies （NBs） showed disorganized arrangement of rough endoplasmic reticulum （rER） cisternae. The motoneuron cell bodies were of regular shape and size at week 4. Nuclei returned to their normal central location and contour. Many lipofuscin granules and lysosomes were observed in the motoneuron cytoplasm, α-motoneurons appeared to have normal cell bodies; the nuclei were perfectly round, but slightly enlarged with enlarged nucleoli at week 8. There was almost complete recovery of the α-motoneurons. CONCLUSION： α-motoneurons of the C8 spinal segment can survive in the right ventral root in rats after transection at the right ventral rootlets junction to the dorsal rootlets, α-motoneurons of the C8 spinal segment in rats can survive for 4 weeks after avulsion injury. Thereafter, signs of degeneration occur, and the degenerative process proceeds in a zonal pattern.展开更多
BACKGROUND： Because the artery leading to the glossopharyngeal nerve is small and complex, insufficient blood supply can occur due to atherosclerosis, occlusion, or injury. This sometimes results in corresponding ner...BACKGROUND： Because the artery leading to the glossopharyngeal nerve is small and complex, insufficient blood supply can occur due to atherosclerosis, occlusion, or injury. This sometimes results in corresponding nerve degeneration, demyelination, and/or arachnoid adhesion. OBJECTIVE： To observe the nutrient artery origin of the glossopharyngeal nerve root in the medulla oblongata region, as well as the relationship between the artery and glossopharyngeal nerve root, to verify dependence of primary glossopharyngeal neuralgia, which is related to contact and compression of the nutrient artery of the glossopharyngeal nerve root. DESIGN, TIME AND SETTING： Repetitive measurement. The experiment was performed at Harbin Medical University and Daqing Oilfields General Hospital between November 2006 and April 2007. MATERIALS： Ten cadaver heads （seven male and three female） were supplied by the Department of Anatomy, Harbin Medical University. A total of 15 patients （nine male and six female）, aged 38-56, that suffered from glossopharyngeal neuralgia were treated at Daqing Oilfields General Hospital and were between 38-56 years old. All cadaver heads were strictly handled according to the Guideline for Medical Ethics Committee. The patients agreed to the criteria set for the study objects. METHODS： （1）The bilateral veins of the nutrient artery were dissected under a surgery microscope. A sliding caliper was used to measure the length of the glossopharyngeal nerve from the oblongata to the jugular foramen. The origin of the nutrient artery was noted, as well as the courser and diameter to explore the relationship between the glossopharyngeal nerve root and the vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, as well as the branching veins. （2） A total of 15 patients received glossopharyngeal neuralgia surgery. Contact or oppression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, the anterior inferior cerebellar artery, vertebral artery, and its branches, were evaluated. MAIN OUTCOME MEASURES： The relationship and compression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, anterior inferior cerebellar artery, vertebral artery, and its branches in cadaver sections and the living human body. RESULTS： （1） Cadaver dissection： the nutrient arteries of the glossopharyngeal nerve root originated from three or two branches of the posterior inferior cerebellar artery, anterior inferior cerebellar artery, and dorsolateral medullary artery. During the procedure, four sides of the glossopharyngeal nerve root received contact or compression from the posterior inferior cerebellar artery trunk or thick loop branch. The four sides represented 20% of the area, and the two sides that received glossopharyngeal nerve root contact or compression from the anterior inferior cerebellar artery represented up to 10%. （2） Human living body： during surgery, obvious contact or compression of the glossopharyngeal nerve with three or more branches of the nutrient arteries accounted for 53.3% of the area. CONCLUSION： The cause of a number of primary glossopharyngeal neuralgia is related to contact and pressure of the nutrient artery of the glossopharyngeal nerve root.展开更多
An experimental model of brachial plexus root avulsion injury of cervical dorsal C5-6 was established in adult and neonatal rats.Real-time PCR showed that the levels of brain-derived neurotrophic factor,nerve growth f...An experimental model of brachial plexus root avulsion injury of cervical dorsal C5-6 was established in adult and neonatal rats.Real-time PCR showed that the levels of brain-derived neurotrophic factor,nerve growth factor and neurotrophin-3 in adult rats increased rapidly 1 day after brachial plexus root avulsion injury,and then gradually decreased to normal levels by 21 days.In neonatal rats,levels of the three neurotrophic factors were decreased on the first day after injury,and then gradually increased from the seventh day and remained at high levels for an extended period of time.We observed that greater neural plasticity contributed to better functional recovery in neonatal rats after brachial plexus root avulsion injury compared with adult rats.Moreover, immunohistochemical staining showed that the number of bromodeoxyuridine/nestin-positive cells increased significantly in the spinal cords of the adult rats compared with neonatal rats after brachial plexus root avulsion injury.In addition,the number of bromodeoxyuridine/glial fibrillary acidic protein-positive cells in adult rats was significantly higher than in neonatal rats 14 and 35 days after brachial plexus injury.Bromodeoxyuridine/β-tubulin-positive cells were not found in either adult or neonatal rats.These results indicate that neural stem cells differentiate mainly into astrocytes after brachial plexus root avulsion injury.Furthermore,the degree of neural stem cell differentiation in neonatal rats was lower than in adult rats.展开更多
文摘Objective: This study aims to evaluate the safety and efficacy of PETD combined with nerve root water imaging of MRI for the treatment of lumbar disc herniation. Methods: A retrospective review was performed on 62 patients with lumbar disc herniation from March 2019 to March 2021. The study included an experimental group of 30 patients and a control group of 32 patients. The experimental group underwent PETD combined with nerve root water imaging of MRI, while the control group received traditional PETD treatment. The visual analogue scoring method (VAS score), and JOA lumbar spine function score before and after surgery were compared between the two groups, and efficacy was assessed and compared using the MacNab score. Results: The mean operation time was significantly reduced in the experimental group (56.43 ±10.40 minutes) compared to the control group (65.69 ±14.12 minutes). The VAS score was compared between the two groups with preoperative (p = 0.624), one month after surgery (p = 0.325), three months after surgery (p = 0.676), one year after surgery (p = 0.341);The JOA score was compared between the two groups with preoperative (p = 0.961), one month after the surgery (p = 0.266), three months after surgery (p = 0.185), one year after surgery (p = 0.870), they were no significant statistical difference;The efficacy evaluation of the last follow-up Macnab showed that all the 30 patients in the experimental group were excellent, 31 of 32 patients in the control group were excellent, 1 case was good;There was no statistical difference in the comparison between the two groups (p > 0.05). Conclusion: The study concludes that the combined approach of PETD with nerve root water imaging of MRI is a safe, effective, and more efficient alternative to conventional PETD for treating lumbar disc herniation.
基金supported by the National Natural Science Foundation of China(Grant No.81871773).
文摘The current study aims to ascertain the anatomical feasibility of transferring the contralateral S1 ventral root(VR)to the ipsilateral L5 VR for treating unilateral spastic lower limb paralysis.Six formalin-fixed(three males and three females)cadavers were used.The VR of the contralateral S1 was transferred to the VR of the ipsilateral L5.The sural nerve was selected as a bridge between the donor and recipient nerve.The number of axons,the cross-sectional areas and the pertinent distances between the donor and recipient nerves were measured.The extradural S1 VR and L5 VR could be separated based on anatomical markers of the dorsal root ganglion.The gross distance between the S1 nerve root and L5 nerve root was 31.31(±3.23)mm in the six cadavers,while that on the diffusion tensor imaging was 47.51(±3.23)mm in 60 patients without spinal diseases,and both distances were seperately greater than that between the outlet of S1 from the spinal cord and the ganglion.The numbers of axons in the S1 VRs and L5 VRs were 13414.20(±2890.30)and 10613.20(±2135.58),respectively.The cross-sectional areas of the S1 VR and L5 VR were 1.68(±0.26)mm2 and 1.08(±0.26)mm2,respectively.In conclusion,transfer of the contralateral S1 VR to the ipsilateral L5 VR may be an anatomically feasible treatment option for unilateral spastic lower limb paralysis.
文摘BACKGROUND：It has been shown that interleukin-1 （IL-1） may cause inflammatory reactions, which stimulate the nerve root of patients with lumbar intervertebral disc protrusion and leads to pain. Whether the clinical curative effects of acupuncture in the treatment of lumbar and leg pain are linked to an inhibition of local IL-1 secretion is unknown. OBJECTIVE： To assess the influence of acupuncture on IL-1, this study was designed to verify the effects of acupuncture at the ＂Huatuojiaji （Extra）＂ point on the nerve root in a rat model of lumbar nerve root compression, compared with administration of meloxicam, a non-steroidal anti-inflammatory drug. DESIGN, TIME AND SETTING： Randomized, controlled, molecular biology experiment, performed at the Experimental Center, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between September 2005 and April 2006. MATERIALS： Forty healthy adult Sprague Dawley rats of either gender were included in this study. The rats were randomly and evenly divided into the following four groups： normal control, model, acupuncture and meloxicam groups. Lumbar nerve root compression was induced in rats in the model, acupuncture, and meloxicam groups by inserting a specially made silicon rubber slice at the juncture of the L5 nerve root and the dural sac. The acupuncture needle （pattern number N3030, 30#, 1.5 inch） was purchased from Suzhou Medical Appliance Factory, China. IL-1 enzyme linked immunosorbent assay （ELISA） kit was purchased from Santa Cruz Biotechnology, Inc., USA. METHODS： The acupuncture group was acupunctured at the ＂Huatuojiaji＂ point, which is lateral to the compressed L5-6 nerve root, with an acupuncture depth of 0.5 cm. There were two treatment courses, each of involved seven 20-minute acupuncture sessions, one session a day. The meloxicam group was administered intragastrically 3.75 mg/kg meloxicam （5 mg meloxicam /10 mL physiological saline）. Rats in the normal control group and model group received an intragastric administration of 10 mL/kg physiological saline. All administrations were performed once a day. MAIN OUTCOME MEASURES： At day 14 post-surgery, the IL-1 level in the compressed nerve root was determined by a streptavidin-peroxidase （S-P） immunohistochemical method, and IL-1β mRNA expression in the compressed nerve root was simultaneously detected by real-time reverse transcription-polymerase chain reaction. RESULTS： The expression levels of IL-1 and IL-1β mRNA in the L5 nerve root were significantly higher in the model group than in the control group （P 〈 0.01）. However, the expression levels of IL-1 and IL-1β mRNA were significantly lower in the acupuncture and meloxicam groups than in the model group （P 〈 0.05–0.01）. Expression levels of IL-1 and IL-1β mRNA were significantly higher in the acupuncture group than in the meloxicam group （P 〈 0.01）. CONCLUSION： Acupuncture at the ＂Huatuojiaji＂ point decreases the IL-1 level by inhibiting IL-1β mRNA expression to a greater extent than meloxicam administration.
基金supported by the High Levels of Health Technical Personnel in Beijing Health System of China,No.2013-3-050(to JZY)
文摘Current animal models of nerve root compression due to lumbar disc herniation only assess the mechanical compression of nerve roots and the inflammatory response. Moreover, the pressure applied in these models is static, meaning that the nerve root cannot be dynamically compressed. This is very different from the pathogenesis of lumbar disc herniation. In this study, a chitosan/polyacrylamide double-network hydrogel was prepared by a simple two-step method. The swelling ratio of the double-network hydrogel increased with prolonged time, reaching 140. The compressive strength and compressive modulus of the hydrogel reached 53.6 and 0.34 MPa, respectively. Scanning electron microscopy revealed the hydrogel's crosslinked structure with many interconnecting pores. An MTT assay demonstrated that the number of viable cells in contact with the hydrogel extracts did not significantly change relative to the control surface. Thus, the hydrogel had good biocompatibility. Finally, the double-network hydrogel was used to compress the L4 nerve root of male sand rats to simulate lumbar disc herniation nerve root compression. The hydrogel remained in its original position after compression, and swelled with increasing time. Edema appeared around the nerve root and disappeared 3 weeks after operation. This chitosan/polyacrylamide double-network hydrogel has potential as a new implant material for animal models of lumbar nerve root compression. All animal experiments were approved by the Animal Ethics Committee of Neurosurgical Institute of Beijing, Capital Medical University, China(approval No. 201601006) on July 29, 2016.
基金Modern Projects of Traditional Chinese Medicine of Shanghai Science and Technology Commission, No.08DZ1973200Research Projects of Shanghai Bureau of Public Health,No.2006Q004L
文摘BACKGROUND： Varying degrees of inflammatory responses occur during lumbar nerve root compression. Studies have shown that nitric oxide synthase （NOS） and calcitonin gene-related peptide （CGRP） are involved in secondary disc inflammation. OBJECTIVE： To observe the effects of warm acupuncture on the ultrastructure of inflammatory mediators in a rat model of lumbar nerve root compression, including NOS and CGRP contents. DESIGN, TIME AND SETTING： Randomized, controlled study, with molecular biological analysis, was performed at the Experimental Center, Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University, between September 2006 and April 2007. MATERIALS： Acupuncture needles and refined Moxa grains were purchased from Shanghai Taicheng Technology Development Co., Ltd., China; Mobic tablets were purchased from Shanghai Boehringer Ingelheim Pharmaceuticals Co., Ltd., China; enzyme linked immunosorbent assay （ELISA） kits for NOS and CGRP were purchased from ADL Biotechnology, Inc., USA. METHODS： A total of 50, healthy, adult Sprague-Dawley rats, were randomly divided into five groups normal, model, warm acupuncture, acupuncture, and drug, with 10 rats in each group. Rats in the four groups, excluding the normal group, were used to establish models of lumbar nerve root compression. After 3 days, Jiaji points were set using reinforcing-reducing manipulation in the warm acupuncture group. Moxa grains were burned on each needle, with 2 grains each daily. The acupuncture group was the same as the warm acupuncture group, with the exception of non-moxibustion. Mobic suspension （3.75 mg/kg） was used in the oral drug group, once a day. Treatment of each group lasted for 14 consecutive days. Modeling and medication were not performed in the normal group. MAIN OUTCOME MEASURES： The ultrastructure of damaged nerve roots was observed with transmission electron microscopy; NOS and CGRP contents were measured using ELISA. RESULTS： The changes of the radicular ultramicrostructure were characterized by Wallerian degeneration; nerve fibers were clearly demyelinated; axons collapsed or degenerated; outer Schwann cell cytoplasm was swollen and its nucleus was compacted. Compared with the normal group, NOS and CGRP contents in the nerve root compression zone in the model group were significantly increased （P 〈 0.01）. Nerve root edema was improved in the drug, acupuncture and the warm acupuncture groups over the model group. NOS and CGRP expressions were also decreased with the warm acupuncture group having the lowest concentration （P 〈 0.01）. CONCLUSION： In comparison to the known effects of Mobic drug and acupuncture treatments, the warm acupuncture significantly decreased NOS and CGRP expression which helped improve the ultrastructure of the compressed nerve root.
基金the National Natural Science Foundation of China,No.81171147(to LXL)“Key Medical Talents of Qiangwei Project”Research Foundation of Health Department of Jiangsu Province,No.ZDRCA2016010(to LXL)+3 种基金“Xingwei Project”Key Personal Medical Research Foundation of Health Department of Jiangsu Province,No.RC201156(to LXL)Jiangsu Province’s Key Discipline of Medicine,No.XK201117(to LXL)the Priority Academic Program Development of Jiangsu Higher Education Institutions,PAPD(to LXL)the Natural Science Foundation of Jiangsu Province,No.BK20171064(to BSH).
文摘There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve roots.Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule.The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs.We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage.In a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over time.At 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic side.At 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots.In addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord.Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved.These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal ankle.Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage.All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.IACUC-1906009)in June 2019.
基金supported by the Science and Technology Planning Project of Guangdong Province of China in 2012No.2012B031800232
文摘Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging（T1WI） and T2-weighted imaging（T2WI） scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging（DTI） for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2 WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1 WI and T2 WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots（49%） and abruption in 17 lumbosacral spinal nerve roots（23%）. Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.
基金supported by the National Natural Science Foundation of China,No.H0605/81501871
文摘If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root ＋ posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root ＋ posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root ＋ posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root ＋ posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve.
基金supported by the International Cooperation Projects of Jilin Province Science and Technology Commission,No.20100735
文摘Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re- mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9_10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu- lation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.
基金supported by grants from the Key Topics of China Traditional Chinese Medicine Scientific Research Project,General Logistics Department of Chinese PLA,No.10ZYZ125the Army Medical Science and Technology the125Scientific Research Projects,Chinese PLA,No.AKJ11J004
文摘Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng＇s Spinal Manipulation, hot fomentation, and bed rest （treatment group）. The remaining 46 patients were treated with hot fomentation and bed rest only （control group）. After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng＇s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.
基金This study was reviewed and approved by the Ethics Committee of the Tokat Gaziosmanpasa University Faculty of Medicine(No.19-KAEK-099).
文摘BACKGROUND Redundant nerve roots(RNRs)of the cauda equina are often a natural evolutionary part of lumbar spinal canal stenosis secondary to degenerative processes characterized by elongated,enlarged,and tortuous nerve roots in the superior and/or inferior of the stenotic segment.Although magnetic resonance imaging(MRI)findings have been defined more frequently in recent years,this condition has been relatively under-recognized in radiological practice.In this study,lumbar MRI findings of RNRs of the cauda equina were evaluated in spinal stenosis patients.AIM To evaluate RNRs of the cauda equina in spinal stenosis patients.METHODS One-hundred and thirty-one patients who underwent lumbar MRI and were found to have spinal stenosis between March 2010 and February 2019 were included in the study.On axial T2-weighted images(T2WI),the cross-sectional area(CSA)of the dural sac was measured at L2-3,L3-4,L4-5,and L5-S1 levels in the axial plane.CSA levels below 100 mm^2 were considered stenosis.Elongation,expansion,and tortuosity in cauda equina fibers in the superior and/or inferior of the stenotic segment were evaluated as RNRs.The patients were divided into two groups:Those with RNRs and those without RNRs.The CSA cut-off value resulting in RNRs of cauda equina was calculated.Relative length(RL)of RNRs was calculated by dividing the length of RNRs at mid-sagittal T2WI by the height of the vertebral body superior to the stenosis level.The associations of CSA leading to RNRs with RL,disc herniation type,and spondylolisthesis were evaluated.RESULTS Fifty-five patients(42%)with spinal stenosis had RNRs of the cauda equina.The average CSA was 40.99±12.76 mm^2 in patients with RNRs of the cauda equina and 66.83±19.32 mm^2 in patients without RNRs.A significant difference was found between the two groups for CSA values(P<0.001).Using a cut-off value of 55.22 mm^2 for RNRs of the cauda equina,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)values of 96.4%,96.1%,89.4%,and 98.7%were obtained,respectively.RL was 3.39±1.31(range:0.93-6.01).When the extension of RNRs into the superior and/or inferior of the spinal canal stenosis level was evaluated,it was superior in 54.5%,both superior and inferior in 32.8%,and inferior in 12.7%.At stenosis levels leading to RNRs of the cauda equina,29 disc herniations with soft margins and 26 with sharp margins were detected.Disc herniation type and spondylolisthesis had no significant relationship with RL or CSA of the dural sac with stenotic levels(P>0.05).As the CSA of the dural sac decreased,the incidence of RNRs observed at the superior of the stenosis level increased(P<0.001).CONCLUSION RNRs of the cauda equina are frequently observed in patients with spinal stenosis.When the CSA of the dural sac is<55 mm^2,lumbar MRIs should be carefully examined for this condition.
基金the National Natural Science Foundation of Hainan Province,No.30318
文摘BACKGROUND： Computed Tomography （CT） and Magnetic Resonance Imaging （MRI） can display the site of lumbar spinal stenosis and predict nervous compression at the morphological level; however, pure morphological changes cannot reflect functional alterations in a compressed nerve root. Dermatomal somatosensory evoked potential （DSEP） provides a means to assess the functional state of a nerve root. OBJECTIVE： To evaluate the clinical significance of DSEP, assessing the degree of nerve root injury following lumbar spinal stenosis. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Orthopaedic Surgery, Hainan People＇s Hospital, China, between September 2004 and December 2007. PARTICIPANTS： Forty-seven patients diagnosed with lumbar spinal stenosis by CT or MRI were selected as the case group; fifty healthy subjects were collected as the control group. METHODS： A KEYPOINT myoelectric evoked potential apparatus （DANTEC Company, Denmark） was used to measure DSEP, and stimulative spots were determined in accordance with the skin key sensory spot standards established by The American Spinal Injury Association： L4 in the medial malleolus, L5 in the third metatarsophalangeal joint of the dorsum of foot and S1 in the lateral heel. The needle electrode used as the recording electrode was located at the Cz point of the cranium, and the reference electrode at the Fz point. MAIN OUTCOME MEASURES： Latency of the P40 peak of DSEP, P1-N1 amplitude, P40 waveform and differentiation and disappearance of various waves. RESULTS： The sensitivity and diagnostic concurrence with surgery of nerve root injury following lumbar spinal stenosis evaluated by DSEP was 95.7 %. P40 latencies at L4, L5 and S1 in the case group were significantly longer than in the control group （P 〈 0.05）, and the P1-N1 amplitude in the case group was significantly lower than the control group （P 〈 0.05-0.01）. Nerve root injury was categorized according to DSEP latency as follows： severe damage （disappearance of the P40 wave in 103 dermatomes）, moderate damage （prolongation of the P40 peak latency ≥ 3.0 times the standard deviation of the normal mean in 60 dermatomes） and mild damage （prolongation of the P40 peak latency ≥ 2.5 times the standard deviation of the normal mean in 31 dermatomes）. CONCLUSION： DSEP can be used to determine the severity of nerve root injury following lumbar spinal stenosis with high sensitivity and specificity.
基金the Natural Science Foundation of Hainan Province, No. 30318
文摘BACKGROUND： It has been reported that dermatomal somatosensory evoked potential （DSEP） can be used for diagnosing nerve root injury in patients with lumbar disc herniation （LDH）, and that 83% 95% of patients suffer from the disease. Body height correction is not performed prior to determinations of latency and latency difference between the healthy and affected sides. However, latency noticeably correlates to body height. OBJECTIVE： This study aims to determine the lumbosacral nerve root injury in patients with LDH by DSEP, and to evaluate the sensitivity of the DSEP difference between the healthy and affected sides using a diagnostic index following body height correction. DESIGN： A case-control observation. SETTING： Department of Orthopedic Surgery, Hainan Provincial People＇s Hospital. PARTICIPANTS： Ninety-six patients, comprised of 67 males and 29 females, with an average age of 43 years and a mean body height of 1.65 m （range 1.48-1.81 m）, were recruited for this study. These patients suffered from unilateral lower limb radiation pain and received treatment at the Department of Orthopedic Surgery, Hainan Provincial People＇s Hospital between January 2004 and December 2006. All patients were confirmed to suffer from LDH at the L3-4, L-5, and/or Ls-SI by CT and/or MRI examinations. Central nervous system diseases were excluded. In order to obtain a normal reference value, DSEP was determined for a group of 50 subjects, who concurrently received health examinations in the same department. The subjects had no previous history of back leg pain or nervous system disease. The group of healthy controls included 26 males and 24 females, with an average age of 37 years and a mean body height of 1.63 m （range 1.50-1.80 m）. Written informed consent was obtained from all subjects for laboratory samples. The protocol was approved by the Hospital＇s Ethics Committees. DSEP was determined with myoelectricity-evoked potential equipment （Keypoint, Batch No. 9020A0042591, Dantec Company, Denmark）. METHODS： DSEP of patients with LDH was determined. Constant-voltage square pulse stimulation was used to determine DSEP, with the following parameters： a pulse wave width of 0.2 milliseconds; a saddle-like stimulating electrode; a stimulation intensity 3 times greater than the sensation threshold; a stimulation frequency of 1.5 Hz; mean superposition greater than 100 times; and inter-electrode impedance 〈 5 k Q. The stimulation point was a skin key sensation point confirmed by the American Spinal Injury Association, i.e. L4 at medial malleolus, L5 at the third metatarsophalangeal joint on the dorsum of the foot, and SI at the lateral heel. The recording electrode was a needle electrode, the recording point was Cz, and the reference electrode was Fz. DSEP latency of P40, and latency differences of P40, between the healthy side and the affected side, were determined. DSEP at L4, L5, and S1 nerve roots of the lower limbs of 50 healthy controls were bilaterally determined. The normal values of P40 latency and P40 N50 amplitude were statistically obtained. MAIN OUTCOME MEASURES： Determination of DSEP values. RESULTS： Ninety-six patients with LDH and fifty healthy controls participated in the final analysis. In the healthy controls, the amplitude of DSEP varied greatly, with a mean amplitude co-efficient of variation of 58% for L4, L5, and SI dermatomes. P40 latency was stable, with a mean latency coefficient of variation of 4.7%. In patients with LDH, the P40 wave disappeared. P40 latency was 2.5 times prolonged compared to normal mean value. P40 latency difference between the healthy and the affected side was 2.5 times higher than the normal mean value of the healthy side. CONCLUSION： DSEP can reflect the functional status of lumbosacral nerve root. P40 latency difference between the healthy side and the affected side is the most sensitive diagnosis index for patients with LDH suffering from unilateral lower limb radiation pain.
基金supported by the Key Scientific and Technological Program of Linyi City of China,No.201313026
文摘Most studies on peripheral nerve injury have focused on repair at the site of injury, but very few have examined the effects of repair strategies on the more proximal neuronal cell bodies. In this study, an approximately 10-mm-long nerve segment from the ischial tuberosity in the rat was transected and its proximal and distal ends were inverted and sutured. The spinal cord was subjected to pulsed electrical stimulation at T10 and L3, at a current of 6.5 m A and a stimulation frequency of 15 Hz, 15 minutes per session, twice a day for 56 days. After pulsed electrical stimulation, the number of neurons in the dorsal root ganglion and anterior horn was increased in rats with sciatic nerve injury. The number of myelinated nerve fibers was increased in the sciatic nerve. The ultrastructure of neurons in the dorsal root ganglion and spinal cord was noticeably improved. Conduction velocity of the sciatic nerve was also increased. These results show that pulsed electrical stimulation protects sensory neurons in the dorsal root ganglia as well as motor neurons in the anterior horn of the spinal cord after peripheral nerve injury, and that it promotes the regeneration of peripheral nerve fibers.
文摘BACKGROUND Primary melanomas affecting the central nervous system are very rare,and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer.As a consequence,not much is known about this.CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root.A 64-year-old woman presented with symptoms of numbness in the right side of the neck,pain,and hypoesthesia in the right upper limb which persisted for 1 year.Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4.Magnetic resonance imaging examination revealed a mass(approximately 2.5 cm×1.4 cm×1 cm)in the right side of the spinal canal in the C-2 plane.Based on findings obtained during operation,perioperative examination,pathological diagnosis,and the diagnostic criteria of primary central melanoma proposed by Hayward,the mass was confirmed to be a melanoma of intraspinal nerve root origin.CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal.The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours.Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.
基金funded by the Fundamental Research Funds for the Higher Learning Schools of Youth Teacher Education Program of Sun Yat-sen University in 2009,No.09YKPY05the Natural Science Foundation of Guangdong Province,No.S2011010004708
文摘Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.
基金supported by a grant from Education Ministry of Jiangsu Province,No.08KJB310002Excellent Discipline of Jiangsu Province,No.JX10131801096
文摘In a previous study, heat shock protein 27 was persistently upregulated in ventral motor neurons following nerve root avulsion or crush. Here, we examined whether the upregulation of heat shock protein 27 would increase the survival rate of motor neurons. Rats were divided into two groups： an avulsion-only group （avtflsion of the L4 lumbar nerve root only） and a crush-avulsion group （the L4 lumbar nerve root was crushed 1 week prior to the avulsion）. Immunofluores- cent staining revealed that the survival rate of motor neurons was significantly greater in the crush-avulsion group than in the avulsion-only group, and this difference remained for at least 5 weeks after avulsion. The higher neuronal survival rate may be explained by the upregulation of heat shock protein 27 expression in motor neurons in the crush-avulsion group. Further- more, preconditioning crush greatly attenuated the expression of nitric oxide synthase in the motor neurons. Our findings indicate that the neuroprotective action of preconditioning crush is mediated through the upregulation of heat shock protein 27 expression and the attenuation of neuronal nitric oxide synthase upregulation following avulsion.
文摘BACKGROUND： Nerve root avulsion is a frequent finding in patients with brachial plexus injury following road traffic accidents or as a result of severe arm traction during complicated deliveries. This injury constitutes a challenging clinical and surgical problem. The morphological characteristics of motoneurons after nerve root avulsion deserve further analysis. OBJECTIVE： To study the different morphological changes of α-motoneurons under light and electron microscopy after C8 spinal ventral rootlets avulsion and transection at various stages. DESIGN： Controlled animal study. SETTING： Department of Anatomy, King Faisal University. MATERIALS： The experiment was carried out at the Department of Anatomy, College of Medicine, King Faisal University between January 2005 and March 2006. Six adult Sprague Dawley rats weighing 200-350 g, irrespective of gender, were used for this study. The animals were bred at the animal house, College of Medicine, King Faisal University, and fed on rat maintenance diet. Water and standard diet were supplied ad libitum. Animal interventions were carried out according to animal ethical standards. METHODS： Three animals were randomly chosen for avulsion of the right ventral rootlets of C8 spinal nerves. The other three received transection of the right ventral rootlets of C8 spinal nerves. ①Avulsion experiment： After rats were anesthetized, the right ventral rootlets of C8 spinal nerves were identified. The ventral rootlets were avulsed from the spinal cord by traction with a fine hook （Fine Science Tools Inc., No. 10031-13, Germany）. Traction was exerted in a direction parallel to the course of the spinal root. Under the operating microscope, the C8 segment was exactly located. After checking the successfulness of the surgical procedure, the C8 segment was separated from the spinal cord. The outcome of the avulsion procedure was as follows： two animals had true avulsion, i.e., no remaining stump was attached to the spinal cord surface. One rat had a stump still attached. The animal was sacrificed I week later and was included in the transaction experiment for analysis. ②Transection experiment： Using fine scissors, the ventral rootlets were transected close to the area of the right ventral rootlets junction with the dorsal rootlets. MAIN OUTCOME MEASURES： After the rats were anesthetized, C8 spinal cord segments were collected for the avulsion experiment from 2 rats, 1 rat, and I rat at weeks 1, 4, and 8, respectively, and from 1 rat each after 4 and 8 weeks in the transection experiment. The morphology of α -motoneurons was observed under light microscopic and electron microscopic examination. RESULTS： All six rats were included in the final analysis. ①Avulsion experiment： α-motoneurons of the C8 spinal segment were found to survive avulsion injury up to 4 weeks. Thereafter, signs of degeneration occurred in a gradual process, involving first the most anterior motoneurons and probably proceeding posterior in a zonal pattern. A clear reduction in motoneuron size was noted. The largest cell body detected was smaller than the control. Nuclei were rounded and central. Nissl substance appeared granular and was dispersed over the cytoplasm, and the α -motoneurons were of normal electron density. At 8 weeks, three zones were observed in the ventral horn. The anterior zone was the most affected and showed intensely basophilic shrunken motoneurons. Nearly all nuclei were centrally located, but were irregular in outline. ②Transection experiment： one week after ventral root transection, nuclei were slightly eccentric and irregular in outline, but of normal size. Nucleolar vacuolation was observed in several neurons, and the ultrastructure of the chromatolytic Nissl bodies （NBs） showed disorganized arrangement of rough endoplasmic reticulum （rER） cisternae. The motoneuron cell bodies were of regular shape and size at week 4. Nuclei returned to their normal central location and contour. Many lipofuscin granules and lysosomes were observed in the motoneuron cytoplasm, α-motoneurons appeared to have normal cell bodies; the nuclei were perfectly round, but slightly enlarged with enlarged nucleoli at week 8. There was almost complete recovery of the α-motoneurons. CONCLUSION： α-motoneurons of the C8 spinal segment can survive in the right ventral root in rats after transection at the right ventral rootlets junction to the dorsal rootlets, α-motoneurons of the C8 spinal segment in rats can survive for 4 weeks after avulsion injury. Thereafter, signs of degeneration occur, and the degenerative process proceeds in a zonal pattern.
基金The grant of Oversea Members Program of Education Bureau of Heilongjing Province, No.152 File 2006/2007The Foundation of Oversea Members Program of Harbin Medical University,No.2006/2008
文摘BACKGROUND： Because the artery leading to the glossopharyngeal nerve is small and complex, insufficient blood supply can occur due to atherosclerosis, occlusion, or injury. This sometimes results in corresponding nerve degeneration, demyelination, and/or arachnoid adhesion. OBJECTIVE： To observe the nutrient artery origin of the glossopharyngeal nerve root in the medulla oblongata region, as well as the relationship between the artery and glossopharyngeal nerve root, to verify dependence of primary glossopharyngeal neuralgia, which is related to contact and compression of the nutrient artery of the glossopharyngeal nerve root. DESIGN, TIME AND SETTING： Repetitive measurement. The experiment was performed at Harbin Medical University and Daqing Oilfields General Hospital between November 2006 and April 2007. MATERIALS： Ten cadaver heads （seven male and three female） were supplied by the Department of Anatomy, Harbin Medical University. A total of 15 patients （nine male and six female）, aged 38-56, that suffered from glossopharyngeal neuralgia were treated at Daqing Oilfields General Hospital and were between 38-56 years old. All cadaver heads were strictly handled according to the Guideline for Medical Ethics Committee. The patients agreed to the criteria set for the study objects. METHODS： （1）The bilateral veins of the nutrient artery were dissected under a surgery microscope. A sliding caliper was used to measure the length of the glossopharyngeal nerve from the oblongata to the jugular foramen. The origin of the nutrient artery was noted, as well as the courser and diameter to explore the relationship between the glossopharyngeal nerve root and the vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, as well as the branching veins. （2） A total of 15 patients received glossopharyngeal neuralgia surgery. Contact or oppression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, the anterior inferior cerebellar artery, vertebral artery, and its branches, were evaluated. MAIN OUTCOME MEASURES： The relationship and compression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, anterior inferior cerebellar artery, vertebral artery, and its branches in cadaver sections and the living human body. RESULTS： （1） Cadaver dissection： the nutrient arteries of the glossopharyngeal nerve root originated from three or two branches of the posterior inferior cerebellar artery, anterior inferior cerebellar artery, and dorsolateral medullary artery. During the procedure, four sides of the glossopharyngeal nerve root received contact or compression from the posterior inferior cerebellar artery trunk or thick loop branch. The four sides represented 20% of the area, and the two sides that received glossopharyngeal nerve root contact or compression from the anterior inferior cerebellar artery represented up to 10%. （2） Human living body： during surgery, obvious contact or compression of the glossopharyngeal nerve with three or more branches of the nutrient arteries accounted for 53.3% of the area. CONCLUSION： The cause of a number of primary glossopharyngeal neuralgia is related to contact and pressure of the nutrient artery of the glossopharyngeal nerve root.
基金supported by the Young Scientist Fund of Jilin Provincial Science and Technology Department,No.20090183
文摘An experimental model of brachial plexus root avulsion injury of cervical dorsal C5-6 was established in adult and neonatal rats.Real-time PCR showed that the levels of brain-derived neurotrophic factor,nerve growth factor and neurotrophin-3 in adult rats increased rapidly 1 day after brachial plexus root avulsion injury,and then gradually decreased to normal levels by 21 days.In neonatal rats,levels of the three neurotrophic factors were decreased on the first day after injury,and then gradually increased from the seventh day and remained at high levels for an extended period of time.We observed that greater neural plasticity contributed to better functional recovery in neonatal rats after brachial plexus root avulsion injury compared with adult rats.Moreover, immunohistochemical staining showed that the number of bromodeoxyuridine/nestin-positive cells increased significantly in the spinal cords of the adult rats compared with neonatal rats after brachial plexus root avulsion injury.In addition,the number of bromodeoxyuridine/glial fibrillary acidic protein-positive cells in adult rats was significantly higher than in neonatal rats 14 and 35 days after brachial plexus injury.Bromodeoxyuridine/β-tubulin-positive cells were not found in either adult or neonatal rats.These results indicate that neural stem cells differentiate mainly into astrocytes after brachial plexus root avulsion injury.Furthermore,the degree of neural stem cell differentiation in neonatal rats was lower than in adult rats.
