Universität zu Köln

Bendella, Habib, Rink, Svenja, Woehler, Aliona, Feiser, Janna, Wilden, Andre, Grosheva, Maria, Stoffels, Hans-Juergen, Meyer, Carolin, Manthou, Marilena, Nakamura, Makoto and Angelov, Doychin N. (2019). Anatomic conditions for bypass surgery between rostral (T7-T9) and caudal (L2, L4, S1) ventral roots to treat paralysis after spinal cord injury. Ann. Anat.-Anat. Anz., 222. S. 139 - 146. MUNICH: ELSEVIER GMBH. ISSN 1618-0402

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Abstract

Severe spinal cord injuries cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate. Re-establishing functional activity especially in the lower limbs by reinnervation of the caudal infra-lesional territories might represent an effective therapeutic strategy. Numerous surgical neurotizations have been developed to bridge the spinal cord lesion site and connect the intact supra-lesional portions of the spinal cord to peripheral nerves (spinal nerves, intercostal nerves) and muscles. The major disadvantage of these techniques is the increased hypersensitivity, spasticity and pathologic pain in the spinal cord injured patients, which occur due to the vigorous sprouting of injured afferent sensory fibers after reconstructive surgery. Using micro-surgical instruments and an operation microscope we performed detailed anatomical preparation of the vertebral canal and its content in five human cadavers. Our observations allow us to put forward the possibility to develop a more precise surgical approach, the so called ventral root bypass that avoids lesion of the dorsal roots and eliminates sensitivity complications. The proposed kind of neurotization has been neither used, nor put forward. The general opinion is that radix ventralis and radix dorsalis unite to form the spinal nerve inside the dural sac. This assumption is not accurate, because both radices leave the dural sac separately. This neglected anatomical feature allows a reliable intravertebral exposure of the dura-mater ensheathed ventral roots and their damage-preventing end-to-side neurorrhaphy by interpositional nerve grafts. (C) 2018 Elsevier GmbH. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bendella, Habib UNSPECIFIED UNSPECIFIED UNSPECIFIED Rink, Svenja UNSPECIFIED UNSPECIFIED UNSPECIFIED Woehler, Aliona UNSPECIFIED UNSPECIFIED UNSPECIFIED Feiser, Janna UNSPECIFIED UNSPECIFIED UNSPECIFIED Wilden, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Grosheva, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoffels, Hans-Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Manthou, Marilena UNSPECIFIED UNSPECIFIED UNSPECIFIED Nakamura, Makoto UNSPECIFIED UNSPECIFIED UNSPECIFIED Angelov, Doychin N. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-139170
DOI:	10.1016/j.aanat.2018.12.008
Journal or Publication Title:	Ann. Anat.-Anat. Anz.
Volume:	222
Page Range:	S. 139 - 146
Date:	2019
Publisher:	ELSEVIER GMBH
Place of Publication:	MUNICH
ISSN:	1618-0402
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TO-SIDE NEURORRHAPHY; FUNCTIONAL RECOVERY; NERVE ANASTOMOSIS; HINDLIMB MUSCLES; SKELETAL-MUSCLE; REINNERVATION; IMPLANTATION; RAT; MOTONEURONS; NEUROTIZATION Multiple languages Anatomy & Morphology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13917