Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury
Loss of hand function after cervical spinal cord injury (SCI) impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirect...
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MDPI AG
2016-09-01
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| Series: | Brain Sciences |
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| Online Access: | http://www.mdpi.com/2076-3425/6/4/42 |
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| author | Aurora Messina Natasha Van Zyl Michael Weymouth Stephen Flood Andrew Nunn Catherine Cooper Jodie Hahn Mary P. Galea |
| author_facet | Aurora Messina Natasha Van Zyl Michael Weymouth Stephen Flood Andrew Nunn Catherine Cooper Jodie Hahn Mary P. Galea |
| author_sort | Aurora Messina |
| collection | DOAJ |
| description | Loss of hand function after cervical spinal cord injury (SCI) impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN) and anterior interosseus nerves (AIN). They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible. |
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| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-12-11T06:08:52Z |
| publishDate | 2016-09-01 |
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| spelling | doaj.art-814995e70fde480c8f2a8eb25cc63f0c2022-12-22T01:18:11ZengMDPI AGBrain Sciences2076-34252016-09-01644210.3390/brainsci6040042brainsci6040042Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord InjuryAurora Messina0Natasha Van Zyl1Michael Weymouth2Stephen Flood3Andrew Nunn4Catherine Cooper5Jodie Hahn6Mary P. Galea7Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville 3010, VIC, AustraliaDepartment of Plastic and Reconstructive Surgery, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaDepartment of Plastic and Reconstructive Surgery, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaDepartment of Plastic and Reconstructive Surgery, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaVictorian Spinal Cord Service, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaDepartment of Occupational Therapy, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaDepartment of Occupational Therapy, Austin Health, Studley Road, Heidelberg 3084, VIC, AustraliaDepartment of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville 3010, VIC, AustraliaLoss of hand function after cervical spinal cord injury (SCI) impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN) and anterior interosseus nerves (AIN). They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible.http://www.mdpi.com/2076-3425/6/4/42peripheral nervesspinal cord injurynerve transfer surgerymorphology |
| spellingShingle | Aurora Messina Natasha Van Zyl Michael Weymouth Stephen Flood Andrew Nunn Catherine Cooper Jodie Hahn Mary P. Galea Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury Brain Sciences peripheral nerves spinal cord injury nerve transfer surgery morphology |
| title | Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury |
| title_full | Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury |
| title_fullStr | Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury |
| title_full_unstemmed | Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury |
| title_short | Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury |
| title_sort | morphology of donor and recipient nerves utilised in nerve transfers to restore upper limb function in cervical spinal cord injury |
| topic | peripheral nerves spinal cord injury nerve transfer surgery morphology |
| url | http://www.mdpi.com/2076-3425/6/4/42 |
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