Intercostal-lumbar-spinal nerve anastomoses for cord transection. A preliminary investigation.

Since 1978, 10 intercostal nerve-cauda equina anastomoses and 11 intercostal nerve-lumbar anastomoses were performed for thoracolumbar spinal cord transection. Three to four pairs of intercostal nerves above the traumatic level of the cord were anastomosed with two to four pairs of cauda equina or lumbar nerve roots below the traumatic level, using microsurgical technique. The surgical techniques used for the latter 11 cases were performed through an extraperitoneal approach. The operative technique is described in detail. These 21 cases have been followed-up for six to 48 months. Electromyography (EMG) shows that action potentials are present in several previously paralyzed muscles in 11 cases. Muscle strength of some previously paralyzed muscles in three cases recovered to Grades 1 to 3. There is evidence that intercostal-lumbar-spinal nerve anastomoses provide a chance for neuronal regeneration, but unsatisfactory functional results are still questions for further study.