Purpose
The purpose of this study was to evaluate the efficacy of “paralyzed” nerve transfer
(ie, transfer of an involuntary, nondegenerated, electrically excitable nerve onto
an involuntary, degenerated, non–electrically excitable nerve) and functional electrical
stimulation for reinnervation. We hypothesized that lower motor neuron cell body continuity
with the motor cortex, via intact upper motor neurons, is not necessary for reinnervation
of the extremities.
Methods
Fischer 344 rats had lower thoracic spinal cord injury (SCI) followed by unilateral
tibial nerve transection and delayed peroneal (“paralyzed”) to tibial nerve transfer
(group A) or primary neurorrhaphy (group B). Control groups had SCI and a unilateral
hindlimb incision and nerve exposure only (group C) or a unilateral hindlimb disection
and transection of both the tibial and peroneal nerves (group D). Three months after
surgery, the proximal peroneal (group A) or proximal tibial (groups B, C, and D) nerves
were electrically stimulated in vivo, and gastrocnemius force production was measured on both the operative and nonoperative
hindlimbs. In addition, the distal tibial nerves from both the experimental and control-side
hindlimbs were sectioned and stained with anti-neurofilament protein to determine
total axon counts.
Results
Mean gastrocnemius force return and mean axonal regeneration was 47% and 51%, respectively,
for group A animals (n = 9), 68% and 73% for group B animals (n = 4), 97% and 99%
for group C animals (n = 4), and 0 and 2% for group D animals (n = 4). A 1-way analysis
of variance for independent samples yielded significant differences between groups
A, B, and C for gastrocnemius force return and between all groups for axonal regeneration.
Conclusions
Paralyzed nerve transfer produces a mean of approximately 50% return of gastrocnemius
force and axonal regeneration. Paralyzed nerve transfer combined with functional electrical
stimulation is a viable method for reanimating denervated motor units in the setting
of SCI.
Key words
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Article info
Publication history
Accepted:
November 14,
2008
Received:
June 25,
2008
Footnotes
Financial support for this work was entirely provided by a grant from the National Institute of Neurological Disorders and Stroke (NINDS).
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
