[Experimental study on reimplantation of ventral root into spinal cord after brachial plexus avulsion]

Li Han, Shilian Kan, Jianjun Yuan
Chinese Journal of Reparative and Reconstructive Surgery 2007, 21 (9): 948-52

OBJECTIVE: To investigate the survival effect and reaction mechanisms of motor neurons after reimplantation of the avulsed root into the spinal cord, and to observe the survival and differentiation in the spinal cord after brachial plexus roots avulsion.

METHODS: Thirty adult Wistar rats were randomly devided into the control group and the experimental group (n = 15). Laminectomy of C4-6 was performed via a posterior approach. The ventral and dorsal roots of C5,6 were both avulsed from the spinal cord outside the dura mater and within the vertebral canal. For the experimental group, the ventral root of C6 was reimplanted into the ventral horn under microscope. The dorsal root was left. The ventral and dorsal roots of C5 were placed inside the nearby muscles. For the control group, the ventral and dorsal roots of both C5 and C6 were placed inside the nearby muscles. At 2, 4, 6, 8, 12 weeks postoperatively, the C6 spinal cord was stained with HE. The changes of the number and morphology of motor neurons were observed on HE-stained sections. The C6 spinal nerve root was stained with silver nitrate, and the regeneration of nerve fiber was observed.

RESULTS: All rats were recovered well and their wounds were healed at primary stage. The gross observation showed that the avulsed nerve roots in control group adhered to adjacent muscles, however the one in experimental groups which had been implanted into spinal cord adhered to scar tissues and were not separated from spinal cord. At each time point postoperatively, the HE-stained transverse sections showed that the number of motor neurons decreased significantly with soma swollen and atrophied, Nissle bodies decreased or disappeared. The survival rates of motor neurons in the control group were 60.9% +/- 5.8%, 42.3% +/- 3.5%, 30.6% +/- 6.1%, 27.5% +/- 7.9% and 20.4% +/- 6.8% respectively; in the experimental group, the survival rates were 67.1% +/- 7.4%, 56.35% +/- 4.6%, 48.7% +/- 8.8%, 44.2% +/- 5.5% and 42.5% +/- 8.3% respectively. The survival rates of motor neurons in the experimental group was higher than those in the control group at all time points, showing statistically significant difference (P < 0.01). At 12 weeks postoperatively, the silver nitrate stained specimen from the C6 nerve root showed regeneration of the motor neurons in the ventral horn into the reimplanted nerve root through axon in the experimental group, but the degeneration of the nerve fiber appeared and the number of the myelinated nerve fiber decreased in the control group.

CONCLUSION: Through reimplantation of the avulsed ventral nerve root into the ventral horn, degeneration of the motor neurons in the ventral horn can be reduced. After reimplantation of avulsed nerve root, there is axonal regrowth of motor neurons into the spinal nerve root and regeneration of the myelinated nerve fiber also appears.

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