Department of Hand Surgery, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden.
J Neurosurg. 2012 Feb;116(2):414-7. doi: 10.3171/2011.7.JNS111106. Epub 2011 Aug 12.
Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch.
在臂丛神经根撕脱伤患者的脊髓手术后，已经描述了运动而不是感觉功能。在本专题病例中，通过植入神经移植物，将与运动相关的神经根以及背根神经节远端的感觉脊神经重新连接到脊髓的腹角和背角神经元。在事故和随后的脊髓手术后 10 年，对周围和感觉功能进行了评估。当刺激肌皮神经时，可以引出二头肌牵张反射，并且电生理测试显示二头肌肌肉中存在 Hoffman 反射（H 反射）。功能磁共振成像显示主动和被动屈肘时感觉运动皮层活动。然而，定量感觉测试和接触热诱发电位刺激并未检测到任何皮肤感觉功能。据作者所知，该病例首次表明脊髓手术不仅可以恢复运动功能，而且可以恢复本体感觉，从而完成脊髓反射弧。
