LONG-TERM EFFECTS ON LOWER LIMB FUNCTION AFTER S<sub>1</sub> NERVE ROOT TRANSECTION AS DYNAMIC SOURCE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LEIDeqiao ,  HOUChunlin , ZHAOJianguo , LINHaodong

Department of Orthopedics, Changzheng Hospital, Affiliated to Second Military Medical University, Shanghai, 200003, P. R. China;

Corresponding?author：

HOUChunlin, Email: chunlin_hou@163.com

Keywords：

S₁ nerve root; Dynamic nerve; Lower extremity function; Functional reconstruction

DOI：

10.7507/1002-1892.20150184

Video：

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Objective To evaluate the long-term effects on the lower limb function after S₁ nerve root transection as dynamic source. Methods Between January 2007 and December 2011, 47 patients with atonic bladder dysfunction underwent S₁ nerve root transposition to reconstrut the bladder function. There were 43 males and 4 females, with an average age of 40.7 years (range, 22-66 years). The locations were LS₁ in 33 cases, LS₂ in 5 cases, LS₃ in 2 cases, TS₁₂, LS₁ in 3 cases, LS₁, LS₂ in 1 case, LS₁, LS₃ in 1 case, LS₁, LS₄ in 1 case, and LS₂, LS₃ in 1 case. The anastomosis of the SS₂ or SS₃ nerve root to S1 nerve root was performed from 4 to 24 months (mean, 8 months) after spinal cord injury. The strength of ankle plantar flexion was grade 4 in 5 cases and grade 5 in 42 cases before operation. Results The strength of ankle plantar flexion had no obvious decrease (grade 4 or 5) in 31 cases, reduced 0.5 grade in 16 cases at 2 days after operation. All the patients were followed up 3-8 years (mean, 5.1 years). At 2 weeks after operation, the nerve electrophysiological examination showed neurogenic damage at operated side in most patients, including reduced amplitude tibial nerve in 19 cases, for common peroneal nerve in 13 cases, and for tibial nerve and common peroneal nerve in 9 cases. Except the velocity of common peroneal nerve (t=-1.881, P=0.093), the other electric physiological indexes showed significant differences between at pre- and post-operation (P<0.05). The muscle strength basically recovered to preoperative level (grade 4 or 5) during follow-up, and there was no impairment of lower limb function. Conclusion S₁ transection has no significant effects on lower limb function, so S₁ nerve can be used as dynamic nerve for nerve function reconstruction.

Citation： LEIDeqiao, HOUChunlin, ZHAOJianguo, LINHaodong. LONG-TERM EFFECTS ON LOWER LIMB FUNCTION AFTER S₁ NERVE ROOT TRANSECTION AS DYNAMIC SOURCE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 849-852. doi: 10.7507/1002-1892.20150184 Copy

1.	Lin H,Hou C.Transfer of normal S₁ nerve root to reinnervate atonic bladder due to conus medullaris injury.Muscle Nerve,2013,47(2):241-245.
2.	徐鎮,侯春林,張偉,等.利用正常腰骶神經根重建膀胱反射弧對下肢功能影響的臨床觀察.中華外科雜志,2008,46(3):221-223.
3.	Sun G,Wu Z,Wang X,et al.Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity.Neural Regen Res,2014,9(23):2111-2114.
4.	Alexander AJ,Almeida JD,Shrime M,et al.Novel outpatient approach to lower lip reanimation using a palmaris longus tendon sling.Otolaryngol Head Neck Surg,2011,40(6):481-488.
5.	Senjaya F,Midha R.Nervetransferstrategies for spinal cord injury.World Neurosurg,2013,80(6):e319-326.
6.	Gu YD,Cai PQ,Xu F,et al.Clinical application of ipsilateral C₇ nerve root transfer for treatment of C₅ and C₆ avulsion of brachial plexus.Microsurgery,2003,23(2):105-108.
7.	宋捷,陳亮,顧玉東.同側頸7神經根移位治療臂叢上干根性撕脫傷患肢功能變化的實驗研究.中華手外科雜志,2007,23(6):367-372.
8.	Gordon T,Yang JF,Ayer K,et al.Recovery potential of muscle after partial denervation:a comparison between rats and humans.Brain Res Bull,1993,30(3-4):477-482.
9.	Simonati A,Cavanagh JB.Changes in terminal sprout formation in rat sternocostalis muscle during chronic intoxication with 2,5 hexanedione.Muscle Nerve,1984,7(5):355-361.
10.	徐峰,傅中國,張殿英,等.腰神經根與其支配肌群的電生理定位實驗.中國臨床康復,2006,10(26):16-18.
11.	Lin H,Chen A,Hou C.Contralateral L-6 nerve root transfer to repair lumbosacral plexus root avulsion:experimental study in rhesus monkeys.J Neurosurg,2013,119(3):714-719.
12.	Lin H,Xu Z,Liu Y,et al.The effect of severing L₆ nerve root of the sacral plexus on lower extremity function:an experimental study in rhesus monkeys.Neurosurgery,2012,70(1):170-177.
13.	侯春林,鐘貴彬,謝慶平,等.人工反射弧重建脊髓損傷后弛緩性膀胱排尿功能的臨床初步報告.中華顯微外科雜志,2006,29(2):92-94.
14.	Li Y,Lin H,Zhao L,et al.Unaffected contralateral S₁ transfer for the treatment of lumbosacral plexus avulsion.Injury,2014,45(6):1015-1018.
15.	Zhu L,F Zhang,Yang D,et al.The effect of severing a normal S₁ nerve root to use for reconstruction of an avulsed contralateral lumbosacral plexus:a pilot study.Bone Joint J,2015,97-B (3):358-365.
16.	Senjaya F,Midha R.Nerve transfer strategies for spinal cord injury.World Neurosurg,2013,80(6):e319-326.
17.	陳匯浩,侯春林,雷德橋,等.健側腰骶神經根移位重建腦卒中偏癱下肢運動功能的應用解剖學研究.中國臨床解剖學雜志,2014,32(6):640-643.
18.	Liu Y,Zhou X,Ma J,et al.The diameters and number of nerve fibers in spinal nerve roots.J Spinal Cord Med,2014.[Epub ahead of print].

1. Lin H,Hou C.Transfer of normal S₁ nerve root to reinnervate atonic bladder due to conus medullaris injury.Muscle Nerve,2013,47(2):241-245.
2. 徐鎮,侯春林,張偉,等.利用正常腰骶神經根重建膀胱反射弧對下肢功能影響的臨床觀察.中華外科雜志,2008,46(3):221-223.
3. Sun G,Wu Z,Wang X,et al.Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity.Neural Regen Res,2014,9(23):2111-2114.
4. Alexander AJ,Almeida JD,Shrime M,et al.Novel outpatient approach to lower lip reanimation using a palmaris longus tendon sling.Otolaryngol Head Neck Surg,2011,40(6):481-488.
5. Senjaya F,Midha R.Nervetransferstrategies for spinal cord injury.World Neurosurg,2013,80(6):e319-326.
6. Gu YD,Cai PQ,Xu F,et al.Clinical application of ipsilateral C₇ nerve root transfer for treatment of C₅ and C₆ avulsion of brachial plexus.Microsurgery,2003,23(2):105-108.
7. 宋捷,陳亮,顧玉東.同側頸7神經根移位治療臂叢上干根性撕脫傷患肢功能變化的實驗研究.中華手外科雜志,2007,23(6):367-372.
8. Gordon T,Yang JF,Ayer K,et al.Recovery potential of muscle after partial denervation:a comparison between rats and humans.Brain Res Bull,1993,30(3-4):477-482.
9. Simonati A,Cavanagh JB.Changes in terminal sprout formation in rat sternocostalis muscle during chronic intoxication with 2,5 hexanedione.Muscle Nerve,1984,7(5):355-361.
10. 徐峰,傅中國,張殿英,等.腰神經根與其支配肌群的電生理定位實驗.中國臨床康復,2006,10(26):16-18.
11. Lin H,Chen A,Hou C.Contralateral L-6 nerve root transfer to repair lumbosacral plexus root avulsion:experimental study in rhesus monkeys.J Neurosurg,2013,119(3):714-719.
12. Lin H,Xu Z,Liu Y,et al.The effect of severing L₆ nerve root of the sacral plexus on lower extremity function:an experimental study in rhesus monkeys.Neurosurgery,2012,70(1):170-177.
13. 侯春林,鐘貴彬,謝慶平,等.人工反射弧重建脊髓損傷后弛緩性膀胱排尿功能的臨床初步報告.中華顯微外科雜志,2006,29(2):92-94.
14. Li Y,Lin H,Zhao L,et al.Unaffected contralateral S₁ transfer for the treatment of lumbosacral plexus avulsion.Injury,2014,45(6):1015-1018.
15. Zhu L,F Zhang,Yang D,et al.The effect of severing a normal S₁ nerve root to use for reconstruction of an avulsed contralateral lumbosacral plexus:a pilot study.Bone Joint J,2015,97-B (3):358-365.
16. Senjaya F,Midha R.Nerve transfer strategies for spinal cord injury.World Neurosurg,2013,80(6):e319-326.
17. 陳匯浩,侯春林,雷德橋,等.健側腰骶神經根移位重建腦卒中偏癱下肢運動功能的應用解剖學研究.中國臨床解剖學雜志,2014,32(6):640-643.
18. Liu Y,Zhou X,Ma J,et al.The diameters and number of nerve fibers in spinal nerve roots.J Spinal Cord Med,2014.[Epub ahead of print].

Chinese Journal of Reparative and Reconstructive Surgery

LONG-TERM EFFECTS ON LOWER LIMB FUNCTION AFTER S₁ NERVE ROOT TRANSECTION AS DYNAMIC SOURCE

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LONG-TERM EFFECTS ON LOWER LIMB FUNCTION AFTER S₁ NERVE ROOT TRANSECTION AS DYNAMIC SOURCE