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Somatic and sympathetic tones fluctuate together seamlessly across daily behaviors. In this issue of Cell, Zhang et al. describe populations of spinal projecting neurons in the rostral ventromedial medulla (rVMM) that harmonize somatic motor function and sympathetic activation. The coordinated regulation plays a vital role in supporting behaviors associated with various arousal states.

Background: Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear. Methods: We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5–C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis. Results: We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6 ± 5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the Z scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the Z scores of the cervical spinal nerves but not with the Z score of the vagus nerve. In gastrointestinal evaluation, the cross‐sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy. Conclusions: Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv. [ABSTRACT FROM AUTHOR]

Background: Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation. Materials and methods: This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results. Results: The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%). Conclusion: Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction. [ABSTRACT FROM AUTHOR]

A variety of anatomical techniques, imaging modalities, dyes and contrast agents, were used to document the mechanisms/routes whereby spinal cerebrospinal fluid (CSF) would move beyond the confines of the spinal dura in the American alligator, Alligator mississippiensis. Three pathways for CSF loss were identified: spinal arachnoid granulations, perineural flow along the spinal nerves, and lymphatic drainage (both along the surface of the dura and at the venous plexus surrounding the spinal ganglion). These same three pathways for spinal CSF loss have been documented in mammals, suggesting that they may be a common feature of (at least) amniotes. Crocodilians, including A. mississippiensis, have the largest epidural venous sinus system of any vertebrate, the present study suggests that, as in mammals, the venous complex of the alligator plays a direct role in regulating the absorption of CSF from the spinal compartment. [ABSTRACT FROM AUTHOR]

Objective: To explore the feasibility of single incision C7 nerve transfer surgery through the subarachnoid pathway on the healthy side through anatomical research. Method: Four fresh frozen cadaver specimens were used for the study. Observe and measure the length of C7 nerve root fibers. Divide the front root into 3 bundles and the rear root into 5 bundles. Result: The C7 nerve has a filamentous structure, arranged symmetrically on both sides, and the length of the root fibers gradually shortens from top to bottom. The length of the left anterior root decreased from (12.25 ± 0.68) mm to (9.75 ± 1.40) mm, the length of the right anterior root decreased from (12.95 ± 1.49) mm to (10.00 ± 2.00) mm, the length of the left posterior root decreased from (15.63 ± 1.55) mm to (12.38 ± 0.71) mm, and the length of the right posterior root decreased from (15.48 ± 1.37) mm to (12.30 ± 0.90) mm. The distance from the exit of the C7 nerve from the dura mater to the fusion site in 4 specimens was (10.98 ± 1.21) mm on the left and (10.98 ± 1.391) mm on the right. All four specimens have completed nerve bundle anastomosis. Conclusion: From an anatomical perspective, it is feasible to anastomose the healthy side C7 nerve with the affected side root fibers in the dorsal bundle of the spinal cord after cutting off the dura mater. [ABSTRACT FROM AUTHOR]

Objectives: neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease mainly affecting optic nerves and the spinal cord. Due to the potentially irreversible tissue damage, prevention of relapses is of utmost importance. Methods: We describe the atypical clinical course and pathology results of a patient with anti-aquaporin-4 antibody (anti-AQP4-Ab)-associated NMOSD who developed aseptic meningitis followed by limbic-encephalitis-like presentation with extensive brain lesions upon treatment with rituximab and tocilizumab. Results: The patient developed subacute cognitive decline with magnetic resonance imaging (MRI) evidence of extensive brain white matter lesions. In the hypothesis of an opportunistic brain infection, she underwent brain biopsy of the temporal pole. Pathology results revealed typical NMOSD findings with complement activation, supporting the hypothesis of an atypical presentation of anti-AQP-Ab-associated NMOSD. Accordingly, treatment with the complement-targeting drug eculizumab was started, leading to a dramatic clinical and MRI improvement. Discussion: aseptic meningitis and limbic encephalitis could represent a rare phenotype of anti-AQP4-Ab-associated NMOSD. [ABSTRACT FROM AUTHOR]

Axon-to-soma signaling events drive the changes in gene expression required for the injured axon to shift from non-elongating to growth-competent. Genetic reprogramming of adult neurons back to a growth-compatible state relies on the activation and coordinated actions of several transcription factors and epigenetic modifiers. Local translation supplies the injured axon with the necessary proteins to carry out the regenerative program. Neurons activate intrinsic energetic repair mechanisms to remobilize axonal mitochondria and meet the high energy demands of the regenerative process. Several intrinsic barriers to axonal regeneration have been identified, including the presence of functional presynaptic active zones, transcriptional repressors, and inhibitors of critical regenerative signaling pathways. Injury to the central nervous system (CNS) often results in permanent neurological impairments because axons fail to regenerate and re-establish lost synaptic contacts. By contrast, peripheral neurons can activate a pro-regenerative program and regenerate following a nerve lesion. This relies on an intricate intracellular communication system between the severed axon and the cell body. Locally activated signaling molecules are retrogradely transported to the soma to promote the epigenetic and transcriptional changes required for the injured neuron to regain growth competence. These signaling events rely heavily on intra-axonal translation and mitochondrial trafficking into the severed axon. Here, we discuss the interplay between these mechanisms and the main intrinsic barriers to axonal regeneration. We also examine the potential of manipulating these processes for driving CNS repair. [ABSTRACT FROM AUTHOR]

Purpose: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. Methods: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. Results: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33–3.509)] and movement [2.40 (1.20–4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100–300); Group 2: 37.5 (0–200); p < 0.001]. Conclusion: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907). [ABSTRACT FROM AUTHOR]

Although activation of astrocytes is critical in developing neuropathic pain (NP) following nerve injury, the underlying mechanisms of NP and therapeutic management for NP are still vague. Importantly, the decreases in the levels of astrocytic glutamate transporter‐1 (GLT‐1) in the spinal dorsal horn result in enhanced excitatory transmission and cause persistent pain. P2Y1 purinergic receptor (P2Y1R) has been shown to enhance many inflammatory processes. The up‐regulated expression of astrocytic P2Y1R is crucial to participate in pain transduction under conditions of nerve injury and peripheral inflammation considering that P2Y1R is potentially involved in glutamate release and synaptic transmission. This study indicates that the expression of P2Y1R in the spinal cord was increased accompanied by the activation of A1 phenotype astrocytes in the rat model of spinal nerve ligation (SNL). Astrocyte‐specific knockdown of P2Y1R alleviated SNL‐induced nociceptive responses and mitigated A1 reactive astrocytes, which subsequently increased GLT‐1 expression. Conversely, in naïve rats, P2Y1R over‐expression induced a canonical NP‐like phenotype and spontaneous hypernociceptive responses and increased the concentration of glutamate in the spinal dorsal horn. Besides, our in vitro data showed that the proinflammatory cytokine tumour necrosis factor‐alpha contributes to A1/A2 astrocyte reactivity and Ca2+‐dependent release of glutamate. Conclusively, our results provide novel insights that as a significant regulator of astrocytic A1/A2 polarization and neuroinflammation, P2Y1R may represent a potential target for the treatment of SNL‐induced NP. [ABSTRACT FROM AUTHOR]

Phase 1: to determine the feasibility of desensitizing ventral branches of spinal nerves within the rectus sheath using an ultrasound-guided rectus sheath block (USRSB). Phase 2: to determine the effect of preoperative USRSB on intraoperative responses to surgical stimulation and postoperative pain. Cadaveric study and prospective, randomized, blinded, parallel-arm clinical trial. A group of five cat cadavers and 37 shelter-owned cats undergoing ovariohysterectomy. Phase 1: anatomical dissection was performed on one uninjected cadaver. Abdominal walls were dissected in four cadavers (eight hemiabdomens) following bilateral USRSB using 1:1 new methylene blue and 0.5% bupivacaine (0.8 mL kg–1 total). Phase 2: preoperative bilateral USRSB was performed with 0.8 mL kg–1 of 0.25% bupivacaine (RSB) or equivalent volume of 0.9% saline (CONTROL). Intraoperative systolic arterial blood pressure (SAP), heart rate (HR), respiratory rate (f R) and vaporizer setting (vap%) were recorded before skin incision, during celiotomy and abdominal wall closure. In recovery, cats were administered robenacoxib (2 mg kg–1; CONTROL) or 0.9% saline (0.1 mL kg–1; RSB) subcutaneously. Postoperative pain was evaluated for 6 hours using the Glasgow Composite Measure Pain Scale. Phase 1: spinal nerves T9–L3 were identified within the rectus sheath, and stained in 0%, 40%, 63%, 75%, 100%, 88%, 50% and 13% of hemiabdomens, respectively. Phase 2: 37 cats were included (RSB, n = 17; CONTROL, n = 20). Intraoperatively, SAP, HR and f R were not significantly different between groups. Vap% was significantly lower in RSB during celiotomy (p = 0.036) and closure (p = 0.044). Postoperatively, RSB cats were 5.3 times (95% CI 1.8–8.3) more likely to require rescue analgesia than CONTROL cats. During surgery, USRSB with bupivacaine offered minor benefits and provided markedly less postoperative analgesia than robenacoxib, indicating that relying on USRSB provides insufficient postoperative analgesia for ovariohysterectomy in cats. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of an ultrasound-guided technique targeting the medial branches of the dorsal ramus of the spinal nerves (DRSN) by injecting a dye solution at the caudal aspect of the base of lumbar mammillary processes [i.e. the retromammillary (RM) space]. Feasibility, descriptive, anatomical study. Eleven canine cadavers. Using anatomical dissections, the relationship between the mammillary processes and the branches of the DRSN of the thoracolumbar and lumbar spine was studied in two cadavers. Subsequently, ultrasound-guided RM injections were administered in nine cadavers, randomly assigned to low volume (LV; 0.01 mL kg–1) of a dye solution at multiple points from L3 to L6 on one side, and high volume (HV; 0.4 mL kg–1) at a single L4 point on the contralateral side. Gross anatomical dissections were immediately performed after the injections. The RM injections were feasible if ultrasonographic landmarks were identifiable in at least 80% of cases, and 80% of LV injections showed medial branch staining. A one-sample binomial test was used for testing feasibility. The medial branches emerged shortly after the DRSN exited the intervertebral foramen and traveled towards the caudal aspect of the base of the mammillary process, which served as the target injection point. With LV, 36 out of 36 (100%) injected medial branches were stained, meeting the criteria of feasibility (p < 0.001). The median (range) number of stained medial branches per cadaver were 4 (4–4) and 2 (1–3), with LV and HV, respectively. Although no lateral branches were stained with LV, 1 (0–2) was stained with HV. Neither ventral branch staining nor epidural spread was noted in any cadaver. Ultrasound-guided RM injections are feasible and allow for selective staining of the medial branch of the DRSN in canine cadavers at the lumbar spine. [ABSTRACT FROM AUTHOR]

Neurogenic lower urinary tract dysfunction (NLUTD) is a frequent consequence of spinal cord injury (SCI), leading to symptoms that significantly impact quality of life. Although many life-saving techniques are available, current treatment strategies for managing NLUTD still exhibit limitations and drawbacks. Here, we introduce a new electrical neuromodulation strategy involving electrical stimulation of the major pelvic ganglion (MPG) to initiate bladder contraction, in conjunction with innovative programmable (IPG) electrical stimulation on the pudendal nerve (PN) to induce external urethral sphincter (EUS) relaxation in freely moving or anesthetized SCI mice. Furthermore, we conducted the void spot assay, and cystometry coupled with EUS electromyography (EMG) recordings to evaluate voiding function, and monitor bladder pressure and EUS activity. Our findings demonstrate that our novel electrical neuromodulation approach effectively triggers coordinated bladder muscle contraction and EUS relaxation, effectively counteracting SCI-induced NLUTD. Additionally, this electrical neuromodulation method enhances voiding efficiency, closely resembling natural reflexive urination in SCI mice. Thus, our study offers a promising electrical neurostimulation approach aimed at restoring physiological coordination and potentially offering personalized treatment for improving voiding efficiency in individuals with SCI-associated NLUTD. [ABSTRACT FROM AUTHOR]

Background: The self-locking cage (ROI-C, LDR, Troyes, France) has been clinically applied in the treatment of cervical degenerative disc disease (CDDD). However, only a few long-term clinical and radiographic studies have been conducted on the treatment of spinal cord injury without fracture or dislocation (SCIWFD) so far. A comparison between ACDF with either ROI-C or CCP was performed to determine the better treatment for SCIWFD. Methods: A total of 83 patients who underwent ACDF using either ROI-C or CCP were reviewed for radiological and clinical outcomes. The cohort comprised 60 males and 23 females, aged between 32 and 88 years old, with an average age of 58.23 years. All patients exhibited symptoms of nerve injury, including limb numbness, muscle weakness, hypoesthesia or urinary dysfunction. The preoperative ASIA classification of spinal nerve function: 7 cases of grade A, 23 cases of grade B, 34 cases of grade C and 19 cases of grade D were included in the study. Results: A total of 48 patients underwent ACDF with ROI-C, while 35 patients received a conventional cage-plate. They were studied with a follow-up of 28.63 ± 17.41 months and 29.48 ± 15.43 months respectively. No significant difference was found in blood loss, JOA and ASIA between the two groups. No significant difference was found in cervical lordosis (CL) (P > 0.05). However, statistical difference was found in disc height of fused segment and T1 slope between the two groups (P < 0.05). No statistical difference was in the incidence of cage subsidence (P > 0.05). There was significant difference in the incidence of dysphagia. Both of two groups achieved bony fusion at final follow-up. Conclusion: Our study demonstrated that ROI-C has the same efficacy as CCP in improving the cervical stability in treatment of SCIWFD. The migration of cage didn't occur in ROI-C group at final follow-up, showing steadily fixed in cervical column. Moreover, the ROI-C does have the advantages of good therapeutic effect, mis-invasive, shorter operation time and fewer complications. [ABSTRACT FROM AUTHOR]

Background: Conjoined twins are a rare congenital anomaly with various types, depending on the connection site. Managing these cases requires a structured approach leading to separation surgery. This report provides a detailed description of the anesthetic strategies and challenges of pygopagous conjoined female twins who underwent 2 surgeries before separation at 17 weeks of age. Case Report: The female twins were conjoined at the sacral level (S4), with fused thecal sacs at L5 and cord tethering, with the conus terminating below L3 in both patients. They had separate rectal ampullae that fused into a single anal canal in the midline in a Y formation. The babies underwent 2 surgeries prior to separation: meningocele repair for twin B and anal canal dilation and sphincter mapping for both twins, followed by a ventriculoperitoneal shunt insertion for twin B. The separation surgery included dividing the bony vertebral fusions and dural sacs, untethering the spinal cords and nerves, and correctly allocating the intrapelvic muscles, guided by sphincter muscle mapping. Anesthesia was managed by 2 distinct teams each time, with duplicated equipment and color-coded medications to prevent errors. Due to the critical condition of twin B, general anesthesia was administered to her first. The report also addresses the challenges faced during the 3 surgical procedures. Conclusions: Anesthetic management for pygopagus twins presents complex challenges. Despite limited experience with similar cases, successful management was achieved through planning, effective communication, and rehearsal of unfamiliar setups. Attention to detail and involvement of highly experienced teams were crucial to the success of the procedures. [ABSTRACT FROM AUTHOR]

Simple Summary: The lateral thoracic wall of cats is innervated by the rami cutanei laterales (RCL) emerging from the intercostales nerves from the second to the twelfth thoracic spinal nerve (T). The ultrasound-guided deep serratus plane (DSP) block is a technique that aims to desensitise these RCL to provide analgesia of the lateral wall of the thorax cranial to the 8th rib. This study aimed to assess the distribution of a mixture of dye and contrast media injected in the fascial plane constituted by the lateral aspect of the intercostales externi muscles and the ribs and the medial aspect of the serratus ventralis thoracis muscle. To fulfil this objective, 14 cat cadavers were employed, and a mixture of methylene blue and iopromide 50:50 was injected in the target fascial plane at the laterocaudal aspect of the 5th rib. Cadavers were then subjected to a computed tomographic exam and anatomical dissection. Our results showed staining of the RCL of the intercostales nerves from T2 to T7. These results show that the DSP block could provide analgesia to the lateral aspect of the cranial wall in cats. The serratus plane block is an ultrasound-guided anaesthetic technique that aims to provide analgesia to the lateral thoracic wall cranial to the 8th rib. This block can be performed in a superficial (between the latissimus dorsi and the serratus ventralis thoracis (SVT) muscles) or deep plane (between the intercostales externi and the SVT muscles). This study aimed to assess the distribution and nerve staining of a mixture of 0.4 mL kg−1 of methylene blue and iopromide 50:50 performing a deep serratus plane (DSP) block at the level of the 5th rib. We hypothesise that this technique would be feasible and could stain the rami cutanei laterales (RCL) of the intercostales nerves cranial to the 8th rib in cat cadavers. This study was divided into two phases. Phase 1 consisted of an anatomical study of the thoracic wall (2 cadavers). Phase 2 consisted of the ultrasound-guided injection of the aforementioned mixture and the assessment of its distribution by computed tomography and anatomical dissection (12 cadavers). Contrast media spread a median of 5.5 (2.5–7.5) intercostal spaces. The dye stained a median of 3 (0–5) RCL, affecting RCL 2 (17.39%), RCL 3 (57.17%), RCL 4 (78.26%), RCL 5 (91.30%), RCL 6 (78.26%), and RCL 7 (8.70%) within the DSP. Occasionally, the rami dorsales laterales and the thoracicus longus nerve were stained. Based on these findings, the DSP block performed with a volume of 0.4 mL kg−1 of an anaesthetic could provide analgesia in the area innervated from T4 to T6. [ABSTRACT FROM AUTHOR]

Paired associative stimulation (PAS) is a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). PAS can induce long‐term potentiation (LTP)‐like plasticity in humans, manifested as motor‐evoked potential (MEP) enhancement. We have developed a variant of PAS ("high‐PAS"), which consists of high‐frequency PNS and high‐intensity TMS and targets spinal plasticity and promotes rehabilitation after spinal cord injury (SCI). Vagus nerve stimulation (VNS) promotes LTP‐like plasticity and enhances recovery in SCI and stroke in humans and animals when combined with repetitive motor training. We combined high‐PAS with simultaneous noninvasive transcutaneous auricular VNS (aVNS) to determine if aVNS enhances the extent of PAS‐induced MEP amplitude increase. Sixteen healthy participants were stimulated for 20 min in four different sessions (PAS, PAS + aVNS, PAS + shamVNS, and aVNS) in a randomized single‐blind setup. MEPs were measured before, immediately after, and at 30, 60, and 90 min post‐stimulation. Stimulation protocols with PAS significantly potentiated MEPs (p = 0.005) when compared with aVNS (p = 0.642). Although not significant, MEP enhancement observed after PAS (43.5%) is further increased by aVNS (49.7%) and electrical earlobe stimulation (63.9%). Our aVNS setup failed to significantly enhance the effect of PAS, but sham VNS revealed a trend towards enhanced plasticity. Optimization of auricular VNS stimulation setup is required for possible tests of patients with SCI. [ABSTRACT FROM AUTHOR]

Purpose: Recently, exoscope was introduced as a more ergonomic alternative to microscope, mainly in nerve and spinal surgery. Exoscope use in general surgery is still experimental and just few reports are present in literature. Here, we describe for the first time its application in transanal surgery, specifically during the transanal transection and single-stapled anastomosis in ileal-pouch anal anastomosis. Methods: After completing the proctectomy and pouch formation laparoscopically, two surgeons performed the transanal transection and single-stapled anastomosis using the vision provided by the ORBEYE™ exoscope system with a 3D 4K orbital camera and a 55-inches 3D screen. The transanal procedure was carried out with the surgeons looking at the 3D screen rather than at the operating field. Results: The system subjectively provided excellent operative view thanks to the magnification capacity and the high resolution. The ergonomics was improved compared to classical transanal surgery, allowing the operators and observers to have the same view in a comfortable position. In particular, the exoscope magnified vision allowed for clearer demonstration of techniques to trainees. Conclusions: This is the first report on the intraoperative application of the ORBEYE™ surgical exoscope in transanal surgery. The magnified vision allowed precise movements and the system appeared potentially a ground-breaking tool for surgical training. The ability to project high-quality images to observers make it ideal for teaching complex transanal procedures. Further studies are encouraged to validate this approach into standard colorectal practice. [ABSTRACT FROM AUTHOR]

Summary Background Objective Study design Methods Results Main limitations Conclusions Several perineural injection techniques have been described to medicate the cervical spinal nerves of horses with suspected radiculopathy due to lesions at the intervertebral foramen (IVF). The technique and outcome have never been described in live, standing horses with suspected clinical disease.To assess the safety and efficacy of medication of the ventral rami of the cervical spinal nerves (VRCSNs) for the treatment of cervical radiculopathy in horses.Case series.Horses that underwent ultrasound‐guided perineural injection of the VRCSNs following radiographic and/or computed tomography (CT) evaluation of the cervical spine were included. Perineural injection with corticosteroids was performed using a standardised technique under ultrasound guidance as previously described. Outcome data were collected by clinical record review and unstructured follow‐up telephone conversations.Forty‐seven injections of the VRCSNs were performed in 12 horses with only two self‐limiting adverse reactions noted. All horses that underwent CT examination had at least one site of IVF narrowing with the foramina at the C6/C7 articulation most frequently affected. Nine horses improved following medication of the VRCSNs with eight returning to their previous levels of exercise. All seven horses that underwent CT of the cervical spine had an initial improvement in clinical signs. Six horses were in full work and still performing at their intended level of exercise at a median of 21.5 months post injection.Lack of definitive diagnosis of spinal nerve compression without histopathology of the spinal nerves which is not possible in the live horse.Medication of the VRCSNs is a safe treatment option which may provide benefit to horses with suspected spinal nerve compression but should be reserved for horses that have undergone a detailed clinical examination and CT evaluation of the cervical spine. [ABSTRACT FROM AUTHOR]

Neuropathic pain is a debilitating chronic condition that lacks effective treatment. The role of cytokine- and chemokine-mediated neuroinflammation in its pathogenesis has been well documented. Follistatin (FST) is a secreted protein known to antagonize the biological activity of cytokines in the transforming growth factor–β (TGF-β) superfamily. The involvement of FST in neuropathic pain and the underlying mechanism remain largely unknown. Here, we report that FST was up-regulated in A-fiber sensory neurons after spinal nerve ligation (SNL) in mice. Inhibition or deletion of FST alleviated neuropathic pain and reduced the nociceptive neuron hyperexcitability induced by SNL. Conversely, intrathecal or intraplantar injection of recombinant FST, or overexpression of FST in the dorsal root ganglion (DRG) neurons, induced pain hypersensitivity. Furthermore, exogenous FST increased neuronal excitability in nociceptive neurons. The biolayer interferometry (BLI) assay and coimmunoprecipitation (co-IP) demonstrated direct binding of FST to the insulin-like growth factor–1 receptor (IGF1R), and IGF1R inhibition reduced FST-induced activation of extracellular signal–regulated kinase (ERK) and protein kinase B (AKT), as well as neuronal hyperexcitability. Further co-IP analysis revealed that the N-terminal domain of FST exhibits the highest affinity for IGF1R, and blocking this interaction with a peptide derived from FST attenuated Nav1.7-mediated neuronal hyperexcitability and neuropathic pain after SNL. In addition, FST enhanced neuronal excitability in human DRG neurons through IGF1R. Collectively, our findings suggest that FST, released from A-fiber neurons, enhances Nav1.7-mediated hyperexcitability of nociceptive neurons by binding to IGF1R, making it a potential target for neuropathic pain treatment. Editor's summary: Neuroinflammation contributes to the pathogenesis of neuropathic pain. The characterization of signaling pathways involved could help to identify new therapeutic targets. Here, Jiang et al. used a mouse model to show that the glycoprotein follistatin (FST) was up-regulated in sensory neurons in the dorsal root ganglia (DRG) after spinal nerve ligation. FST injections were sufficient to drive mechanical hypersensitivity and excitability of DRG neurons. FST interacted with insulin-like growth factor–1 receptor, and a peptide that blocked these interactions could alleviate neuropathic pain–related behaviors and FST-mediated voltage-gated sodium channel currents, highlighting a potential therapeutic strategy that warrants further examination. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Distal nerve transfers are frequently used for the treatment of patients having brachial plexus injuries. Spinal accessory nerve to suprascapular nerve transfer by dorsal approach is advantageous since it brings the site of neurotization closer to the neuromuscular end plate and minimizes donor muscle weakness. This surgery is found to be challenging owing to the small and deep operative field. In this article, the authors describe the surgical technique for this procedure. [ABSTRACT FROM AUTHOR]

The thermal grill illusion (TGI), a phenomenon in which the juxtaposition of innocuous warm and cold temperatures on the skin elicits a burning sensation, offers a unique perspective to how pain occurs in response to harmless stimuli. We investigated the role of the spinal cord in the generation of the TGI across 2 experiments (total n580). We applied heat and cold stimuli to dermatomes, areas of skin innervated by a single spinal nerve, that mapped onto adjacent or nonadjacent spinal segments. Enhanced warm and burning ratings during the TGI were observed when cold and warm stimuli were confined within the same dermatome. Furthermore, we found the spatial organisation of warm and cold stimuli within and across dermatomes affected TGI perception. Perceived warmth and burning intensity increased when the cold stimulus projected to the segment more caudal to the warm stimulus, whereas perceived cold during the TGI decreased compared with the opposite spatial arrangement. This suggests that the perception of TGI is enhanced when cold afferents are projected to spinal segments positioned caudally in relation to those receiving warm afferents. Our results indicate distinct interaction of sensory pathways based on the segmental arrangement of afferent fibres and are consistent with current interpretations of the spread and integration of thermosensory information along the spinal cord. [ABSTRACT FROM AUTHOR]

Electrical stimulation has been integrated in recent decades into rehabilitation protocols following neuromuscular injuries. Existing literature supports the utilisation of prolonged or continuous stimulation generated by implantable or transcutaneous devices for chronic pain subsidence and muscle trophism maintenance, which improve outcomes following microsurgical interventions. Newer uses include brief electrical stimulation for peripheral nerve injury. Brief electrical stimulation has shown promise in expediting regeneration of both torn and crushed nerve axons in the murine model and has been incorporated into a limited number of clinical studies. Augmentation of the natural response of an injured peripheral nerve by electrical stimulation has the potential to accelerate regeneration, presumably leading to improved function and clinical outcomes. We review the existing literature on intraoperative utilisation of electrical stimulation to enhance regeneration, such as neural mechanisms of action and their microscopic effect in animal models, as well as results from initial human studies. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Shoulder dysfunction is one of the most common complications seen in patients who have undergone neck dissection surgery. The prevalence of shoulder dysfunction increases depending on the type and extent of neck dissection surgery. We aim to study the relationship between changes in intraoperative neuromonitoring (IONM) threshold during SAN stimulation, ultrasonographic measurement of muscle size and shear wave elastography with shoulder dysfunction. This is a prospective study. All patients who have undergone neck dissection in our centre have been recruited. Analysis of demographic data, IONM threshold during exposure and pre-closure, shoulder function score, neck disability index score (NDII) and ultrasonographic parameters pre-op and during follow up was done. The cohort was divided into patients who suffered from shoulder dysfunction post op (Group A) and patients with normal shoulder function post op (Group B). Statistical significance were seen in IONM threshold during SAN stimulation and Constant shoulder score for 6 months follow up in Group A. IONM threshold difference during exposure and pre-closure could effectively prognosticate shoulder dysfunction post op. A return of shoulder function could be seen in patients who suffered from shoulder dysfunction if early physiotherapy could be commenced. [ABSTRACT FROM AUTHOR]

Background: Zebrafish have become a key model organism in neuroscience research because of their unique advantages. Their genetic, anatomical, and physiological similarities to humans, coupled with their rapid development and transparent embryos, make them an excellent tool for investigating various aspects of neurobiology. They have specifically emerged as a valuable and versatile model organism in biomedical research, including the study of neurological disorders such as multiple sclerosis. Multiple sclerosis is a chronic autoimmune disease known to cause damage to the myelin sheath that protects the nerves in the brain and spinal cord. Objective: This review emphasizes the importance of continued research in both in vitro and in vivo models to advance our understanding of MS and develop effective treatments, ultimately improving the quality of life for those affected by this debilitating disease. Conclusions: Recent studies show the significance of zebrafish as a model organism for investigating demyelination and remyelination processes, providing new insights into MS pathology and potential therapies. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyze the pathophysiological mechanisms acting in very early classic Guillain‐Barré syndrome (GBS) (≤4 days of symptomatic onset). In this inaugural period, both in GBS and its animal model, experimental autoimmune neuritis, the outstanding pathological feature is inflammatory edema predominating in proximal nerve trunks, particularly spinal nerves, and possibly in preterminal nerve segments. Nerve trunks external to the subarachnoid angle possess epi‐ perineurium that is relatively inelastic and of low compliance. Here such edema can increase endoneurial fluid pressure that, when sufficiently critical, may stretch the perineurium and constrict transperineurial microcirculation, compromising blood flow and producing the potential for ischemic nerve injury, whose consequence is rapid partial or complete loss of nerve excitability. These histopathological features correlate well with electrophysiological and imaging findings reported in early GBS stages. Spinal nerve edema and ischemia help to understand the pattern of Wallerian‐like degeneration observed in the axonal form of GBS, predominating in motor spinal roots at their exit from the dura matter (spinal nerves) with centrifugal distribution in more distant motor nerve trunks, and centripetal extension to the distal portion of intrathecal roots. The similarity of initial pathogenic mechanisms between demyelinating and axonal forms of GBS explains why an early increase of serum biomarkers of axonal damage is detected in both forms. In conclusion, knowledge of the microscopic anatomy of the peripheral nervous system is an essential step for a reliable understanding of pathophysiological mechanisms operating in the early phase of any classic GBS subtype. [ABSTRACT FROM AUTHOR]

Nerve injury can induce aberrant changes in the spine; these changes are due to, or at least partly governed by, transcription factors that contribute to the genesis of neuropathic allodynia. Here, we showed that spinal nerve ligation (SNL, a clinical neuropathic allodynia model) increased the expression of the transcription factor Tbx5 in the injured dorsal horn in male Sprague Dawley rats. In contrast, blocking this upregulation alleviated SNL-induced mechanical allodynia, and there was no apparent effect on locomotor function. Moreover, SNL-induced Tbx5 upregulation promoted the recruitment and interaction of GATA4 and Brd4 by enhancing its binding activity to H3K9Ac, which was enriched at the Trpv1 promotor, leading to an increase in TRPV1 transcription and the development of neuropathic allodynia. In addition, nerve injury-induced expression of Fbxo3, which abates Fbxl2-dependent Tbx5 ubiquitination, promoted the subsequent Tbx5-dependent epigenetic modification of TRPV1 expression during SNL-induced neuropathic allodynia. Collectively, our findings indicated that spinal Tbx5-dependent TRPV1 transcription signaling contributes to the development of neuropathic allodynia via Fbxo3-dependent Fbxl2 ubiquitination and degradation. Thus, we propose a potential medical treatment strategy for neuropathic allodynia by targeting Tbx5. [ABSTRACT FROM AUTHOR]

Scholars usually consider the Historia anatomica corporis humani, published in 1600 by André du Laurens, as an obsolete defense of Galenic principles against the novelty of Vesalian material. Although du Laurens’s book plagiarized many illustrations from Vesalius’s De humani corporis fabrica (1543), critics such as Choulant insisted that the Historia’s iconography had “no particular anatomical or artistic value.” However, four of the Historia’s engravings appear to be original. One of these, the Tabula hæc veram spinalis medullae et nervorum ab ea prodeuntium effigiem exprimit, is now famous for depicting the intradural spinal nerves as a horsetail, leading to the addition of the term cauda equina to the anatomical lexicon. A less flamboyant figure from the same plate shows small blood vessels coursing over the surface of the cervical spinal cord. This drawing may be the first published depiction of anterior spinal arteries and veins. [ABSTRACT FROM AUTHOR]

Background: We describe techniques for safe resection of a Type 3 foramen magnum meningioma with dorsal displacement of the accessory nerve rootlets and vertebral artery which limits ventral access to the tumor. Method: Partial sectioning of the accessory nerve rootlets may help create larger working space. Topical lidocaine placement on the rootlets of the spinal accessory nerve may mitigate trapezius muscle contraction and facilitates further progress throughout tumor resection. Conclusion: Creating safe working corridors between the lower cranial nerves through mobilization or partial sectioning of rootlets in the case of CN XI facilitates tumor resection through a far lateral approach. [ABSTRACT FROM AUTHOR]

Studies indicate that the lysine‐specific demethylase 4A (KDM4A), acts as a key player in neuropathic pain, driving the process through its involvement in promoting neuroinflammation. Emerging evidence reveals that C‐C Motif Chemokine Ligand 2 (CCL2) participates in neuroinflammation, which plays an important role in the development and maintenance of neuropathic pain. However, it remains unclear if KDM4A plays a role in regulating CCL2 in neuropathic pain. This study found that following spinal nerve transection (SNT) of the lumbar 5 nerve root in rats, the expression of KDM4A and CCL2 increased in the ipsilateral L4/5 dorsal root ganglia (DRG). Injecting KDM4A siRNA into the DRGs of rats post‐SNT resulted in a higher paw withdrawal threshold (PWT) and paw‐withdrawal latency (PWL) compared to the KDM4A scRNA group. In addition, prior microinjection of AAV‐EGFP‐KDM4A shRNA also alleviates the decrease in PWT and PWL caused by SNT. Correspondingly, microinjection of AAV‐EGFP‐KDM4A shRNA subsequent to SNT reduced the established mechanical and thermal hyperalgesia. Furthermore, AAV‐EGFP‐KDM4A shRNA injection decreased the expression of CCL2 in DRGs. ChIP‐PCR analysis revealed that increased binding of p‐STAT1 with the CCL2 promoter induced by SNT was inhibited by AAV‐EGFP‐KDM4A shRNA treatment. These findings suggest that KDM4A potentially influences neuropathic pain by regulating CCL2 expression in DRGs. [ABSTRACT FROM AUTHOR]

Objective: Classification guides the surgical approach and predicts prognosis. However, existing classifications of spinal schwannomas often result in a high 'unclassified' rate. Here, we aim to develop a new comprehensive classification for spinal schwannomas based on their presumed origin. We compared the new classification with the existing classifications regarding the rate of 'unclassified'. Finally, we assessed the surgical strategies, outcomes, and complications according to each type of the new classification. Methods: A new classification with 9 types was created by analyzing the anatomy of spinal nerves and the origin of significant tumor portions and cystic components in preoperative magnetic resonance images. A total of 482 patients with spinal schwannomas were analyzed to compare our new classification with the existing classifications. We defined 'unclassified' as the inability to classify a patient with spinal schwannoma using the classification criteria. Surgical approaches and outcomes were also aligned with our new classification. Results: Our classification uniquely reported no 'unclassified' cases, indicating full applicability. Also, the classification has demonstrated usefulness in predicting the surgical outcome with the approach planned. Gross total removal rates reached 88.0% overall, with type 1 and type 2 tumors at 95.3% and 96.0% respectively. The approach varied with tumor type, with laminectomy predominantly used for types 1, 2, and 9, and facetectomy with posterior fixation used for type 3 tumors. Conclusion: The new classification for spinal schwannomas based on presumed origin is applicable to all spinal schwannomas. It could help plan a surgical approach and predict its outcome, compared with existing classifications. [ABSTRACT FROM AUTHOR]

Cannabigerol (CBG), a phytocannabinoid, has shown promise in pain management. Previous studies by our research group identified an increase in pain sensitivity as a consequence of prenatal hypoxia-ischemia (HI) in an animal model. This study aimed to investigate the efficacy of CBG in acute and chronic hyperalgesia induced by prenatal HI. A pharmacological screening was first conducted using hot plate and open-field tests to evaluate the antinociceptive and locomotor activities of animals administered with a 50 mg/kg oral dose of cannabis extract with a high CBG content. Prenatal HI was induced in pregnant rats, and the offspring were used to evaluate the acute antinociceptive effect of CBG in the formalin-induced peripheral pain model, while chronic antinociceptive effects were observed through spinal nerve ligation (SNL) surgery, a model used to induce neuropathic pain. Our results show that CBG exhibited an antinociceptive effect in the hot plate test without affecting the animals' motor function in the open-field test. CBG significantly reduced formalin-induced reactivity in HI offspring during both the neurogenic and inflammatory phases. CBG treatment alleviated thermal and mechanical hypernociception induced by SNL. Biomolecular analysis revealed CBG's ability to modulate expression, particularly reducing TNFα and Nav1.7 in HI male and female rats, respectively. These results highlight CBG as a potential antinociceptive agent in acute and chronic pain models, suggesting it as a promising therapeutic option without inducing motor impairment. Further research is needed to fully elucidate its mechanisms and clinical applications in pain management. [ABSTRACT FROM AUTHOR]

Experimental autoimmune encephalomyelitis is a demyelinating disease that causes paralysis in laboratory rats. This condition lacks treatment that reverses damage to the myelin sheaths of neuronal cells. Therefore, in this study, treatment with EPO as a neuroprotective effect was established to evaluate the ERK 1/2 signaling pathway and its participation in the EAE model. EPO was administered in 5000 U/Kg Sprague Dawley rats. U0126 was used as an inhibitor of the ERK 1/2 pathway to demonstrate the possible activation of this pathway in the model. Spinal cord and optic nerve tissues were evaluated using staining techniques such as H&E and the Luxol Fast Blue myelin-specific technique, as well as immunohistochemistry of the ERK 1/2 protein. The EPO-treated groups showed a decrease in cellular sampling in the spinal cord tissues but mainly in the optic nerve, as well as an increase in the expression of the ERK 1/2 protein in both tissues. The findings of this study suggest that EPO treatment reduces cellular death in EAE-induced rats by regulating the ERK pathway. [ABSTRACT FROM AUTHOR]

Conventionally, neural transfer of the spinal accessory nerve to the suprascapular nerve for shoulder abduction in traumatic brachial plexus injury is performed via the anterior approach. However, important advantages of the posterior approach have made it an alternative option, such as the proximity of neural coaptation to the muscle to be reinnervated and negating the effects of a second injury to the suprascapular nerve. Retrospective data was collected from 30 patients with brachial plexus injury who underwent spinal accessory nerve to suprascapular nerve transfer over 4 years. There were 15 patients in the anterior-approach group (group A) and 15 in the posterior-approach group (group B). Functional outcome at the shoulder was measured as muscle power and active range of motion at 18 months, and data on patients' satisfaction levels and surgeons' perceptions was also collected. No statistical difference was found in the muscle strength achieved in the 2 groups (P = 0.34), but significant recovery was found in the external rotation achieved by group B (P = 0.02). Statistical difference was insignificant in the 2 groups' active range of motion during abduction and external rotation. The satisfaction index of patients was 86.7% in group B as compared to 68% in group A. Surgeons' perspective showed a faster speed of suprascapular nerve exploration in the posterior approach, with better visibility of supraspinatus muscle contraction, and overall surgeons preferred the posterior approach. External rotation at the shoulder is better via the posterior approach, but no difference in abduction was noted. Patients who underwent the posterior approach were more satisfied with the recovery, and surgeons preferred the posterior approach. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a devastating condition that significantly decreases the patient's quality of life. Therefore, treatments that can facilitate nerve regeneration, reduce complications, and increase quality of life are valuable for these patients. In this study, we aimed to assess nerve bypass surgery's feasibility and clinical outcomes by transferring the intercostal nerves into the spinal cord. Eight patients with complete thoracic SCI and delayed presentation more than a year after the injury were analyzed retrospectively. All patients underwent nerve bypass surgery with the transfer of 2 pairs of intercostal nerves from proximal to the injury site to the anterolateral spinal cord, followed by duraplasty with fascia grafting to close the dura. Six of the 8 (75%) patients demonstrated motor and sensory improvements, based on the American SCI Association score. Three patients demonstrated a limited recovery of motor function that could be independently triggered without ICN initiation. Five patients demonstrated evidence of cerebrospinal fluid leakage after surgery; however, only 1 patient complained of a headache. Spinal cord bypass surgery is a potential reconstruction method to treat chronic complete thoracic SCI with functional improvements, and is worth further investigation. [ABSTRACT FROM AUTHOR]

Background: Cluster headache (CH) is a significant health concern due to its major socioeconomic consequences and most patients being refractory to conventional strategies. For treatment resistant CH, occipital nerve stimulation (ONS) is considered an effective treatment option. Whereas most patients do not adjust the amplitude of the ONS system, a subset changes the amplitude on a regular basis using their remote control, and are therefore referred to as 'voltage tuners'. Anxiety and self-control are thought to be central themes to this behavior. Research on this voltage tuning behavior could provide new insights in the use of ONS as acute attack treatment. To date, voltage tuning has not been assessed for CH. Hence this is a unique study aiming to investigate the occurrence and efficacy of voltage tuning in patients with CH and ONS. Methods: For this analysis, patients with CH who received ONS from 2020–2024, at our university medical center, were included. All patients underwent bilateral ONS implantation. Data on attack frequency, intensity and duration were collected retrospectively. Outcomes on the response, frequency, moment during the day, duration, rationale, sensation, average increase in amplitude, and efficacy of voltage tuning were collected with prospective interviews. Results: Thirty-three patients (M = 20) (42 ± 12.7 years) were included in the current analysis. At 1y follow-up, an overall response rate of 70% (23/33) was found for ONS. In total, 48% (18/33) of patients were defined as voltage tuners. Voltage tuning was performed with an average increase in amplitude of 92 (20–360)%, a frequency of 1–20 times/month and duration of 20 minutes-48 hours. Sensations of voltage tuning were described as "tingling" and/or "pinching". The rationale for voltage tuning in patients varied from prevention and ceasing to lowering the intensity and enhance control of CH attack. Conclusions: Outcomes show that voltage tuning may cease and/or terminate CH attacks and therefore raise interests in the use of ONS as acute attack treatment for patients with resistant CH treated with ONS. Future research on the occurrence and potential of voltage tuning will provide valuable insights for achieving optimal efficacy of ONS and quality of life in patients with CH. [ABSTRACT FROM AUTHOR]

Following spinal cord injury (SCI), the regenerative capacity of the central nervous system (CNS) is severely limited by the failure of axonal regeneration. The regeneration of CNS axons has been shown to occur by grafting predegenerated peripheral nerves (PPNs) and to be promoted by the transplantation of neural precursor cells (NPCs). The introduction of a combinatorial treatment of PPNs and NPCs after SCI has to address the additional problem of glial scar formation, which prevents regenerating axons from leaving the implant and making functional connections. Previously, we discovered that the synthetic sulfoglycolipid Tol-51 inhibits astrogliosis. The objective was to evaluate axonal regeneration and locomotor function improvement after SCI in rats treated with a combination of PPN, NPC, and Tol-51. One month after SCI, the scar tissue was removed and replaced with segments of PPN or PPN+Tol-51; PPN+NPC+Tol-51. The transplantation of a PPN segment favors regenerative axonal growth; in combination with Tol-51 and NPC, 30% of the labeled descending corticospinal axons were able to grow through the PPN and penetrate the caudal spinal cord. The animals treated with PPN showed significantly better motor function. Our data demonstrate that PPN implants plus NPC and Tol-51 allow successful axonal regeneration in the CNS. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) primarily infects the respiratory epithelium, but growing evidence suggests that it may also be responsible for neurologic sequelae. In 3-dimensional microphysiologic peripheral nerve cultures, RSV infected neurons, macrophages, and dendritic cells along 2 distinct trajectories depending on the initial viral load. Low-level infection was transient, primarily involved macrophages, and induced moderate chemokine release with transient neural hypersensitivity. Infection with higher viral loads was persistent, infected neuronal cells in addition to monocytes, and induced robust chemokine release followed by progressive neurotoxicity. In spinal cord cultures, RSV infected microglia and dendritic cells but not neurons, producing a moderate chemokine expression pattern. The persistence of infection was variable but could be identified in dendritic cells as long as 30 days postinoculation. This study suggests that RSV can disrupt neuronal function directly through infection of peripheral neurons and indirectly through infection of resident monocytes and that inflammatory chemokines likely mediate both mechanisms. [ABSTRACT FROM AUTHOR]

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This prospective anatomical study aimed to establish an ultrasound-guided technique to the quadratus lumborum (QL) plane in sheep cadavers. Thirteen cadavers, weighing less than 117 kg, were included. In phase 1, one cadaver underwent dissection and two cadavers underwent 3D computed tomographic reconstruction for anatomical evaluation of the thoracolumbar region. In phase 2, two cadavers were used to compare two ultrasound techniques to the QL plane: lateral to the QL muscle with a transversal approach (LQL) and transmuscular between QL and psoas muscles with a longitudinal approach (TQL). For LQL, the reference was the first lumbar transverse process, whereas for TQL, it was the intertransverse region between the first and second lumbar vertebrae. The needle was advanced in-plane towards the specific target for each technique and a total of four injections were performed using 0.4 ml kg−1 of a dye-lidocaine solution. In phase 3, 10 cadavers received bilateral LQL injections (n = 20). All cadavers were then dissected to evaluate spread of dye. In phase 2, following LQL injections, no dye was observed in undesired locations; however, the dye was noted in the retroperitoneal space (1/2) after TQL injections. In phase 3, the 13th thoracic, first, second, third lumbar nerves, and sympathetic trunk segments were stained in 80%, 95%, 100%, 45% and 35% of the injections, respectively. In conclusion, the LQL technique was feasible, allowing staining of the spinal nerves innervating the cranial abdomen in sheep cadavers. Further studies in live animals are warranted. [ABSTRACT FROM AUTHOR]

Background: Spinal synovial cysts (SSCs) are a rare cause of nerve root and spinal cord compression. Surgical excision of SSCs remains the mainstay of treatment in the presence of unremitting symptoms or neurological deficits, but the choice of the surgical approach remains controversial. The goal of this study was to compare clinical outcomes and adverse events associated with traditional approaches (interlaminar or laminectomy/hemilaminectomy) and minimally invasive approaches (microsurgical tubular approaches or endoscopic approaches) for SSCs. Methods: Studies reporting surgical management of SSCs were searched in three online databases (PubMed, the Cochrane Library, and Web of Science). This meta-analysis was reported following the PRISMA Statement. It was registered at the International Prospective Register of Systematic Reviews (CRD42021288992). The Cochrane Collaboration's Risk of Bias in Nonrandomised Studies—of Interventions (ROBINS-I) was used to evaluate bias. Extracted research data were statistically analyzed using Stata 16 and SPSS statistics 25. Results: A total of 22 related relevant studies were included. Meta-analysis revealed no statistically significant difference in dural tear, residual cyst, recurrence, reoperation, and operation time between minimally invasive approaches and traditional approaches (p > 0.05), but minimally invasive approaches had a good functional improvement (p = 0.004). Postoperative length of hospital stays and intraoperative bleeding in traditional approaches were also higher than in minimally invasive approaches (p < 0.05). Conclusion: Based on the available evidence, minimally invasive approaches may be better than traditional approaches in the treatment of SSCs. Minimally invasive approaches had the advantages of improving clinical satisfaction, with a similar complication rate to traditional approaches. Moreover, endoscopic and microsurgical tubular approaches had similar outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the origin and branches of the brachial plexus nerves in S. villosus, as well as the innervated musculature, contributing information to the field of comparative animal anatomy and providing insights for applied studies. Fifteen adult cadavers (eight males and seven females), previously identified, sexed, and fixed with a 10% aqueous formaldehyde solution were used. The patients underwent digital radiographic examinations of the cervical region to characterize the number of cervical vertebrae. The nerves were dissected to visualize the innervation of the intrinsic and extrinsic musculature of the thoracic limb. With the assistance of a costotome, the vertebrae were removed until visualization of the spinal cord and the roots, which gave rise to the nerve branches. The specimens presented seven cervical vertebrae, and the brachial plexus was characterized as postfixed, formed by connections between the last four cervical spinal nerves (C5, C6, C7, and C8) and the first two thoracic nerves (T1 and T2). The cranial, middle, and caudal trunks originate from the suprascapularis, subscapular, axillary, musculocutaneous, radial, median, and ulnar nerves for the intrinsic musculature and from the cranial pectoral, caudal pectoral, lateral thoracic, long thoracic, and thoracodorsal nerves for the extrinsic musculature. The ventral branches that contributed the most to plexus formation in the right antimer were C5 and C8, while in the left antimer, they were C7. The resulting nerves and the innervation for extrinsic and intrinsic musculature were similar to those observed in other rodents and representatives of the Mammalia class in general. [ABSTRACT FROM AUTHOR]

Head and neck cancers are fairly common in India due to the widespread consumption of tobacco and neck dissection is a major component in the surgical management. The objective of this study is to analyze the effect of MRND and SND on shoulder function and quality of life in patients of head and neck cancer. Our study is a prospective comparative study on 65 head and neck cancer patients divided into 2 groups—33 in group A (MRND group) and 32 in group B (SND group). Clinical evaluation of shoulder function was done pre-operatively, 1 week, 1 month, 3 month and 6 month post-operatively using arm abduction scores (AAS) and shoulder pain and disability index (SPADI). Nerve-conduction study (NCS) was done pre-operatively and 3 months post-operatively for assessment of SAN. Neck dissection quality of life questionnaire (NDQOL) was used as a quality-of-life measure. A total of 65 neck dissections were included in the analysis (33 in group A and 32 in group B) out of which 53 were males and 12 were females. The mean AAS on the 6th post-operative month in group A was significantly lower than that of group B (p = 0.01). The mean SPADI scores on the 6th post-operative month was significantly worse in group A than group B (p value 0.01). On NCS, a significant decrease in amplitude was seen in group A (p = 0.02) and a significant increase in latency was noted in group B (p = 0.005). Quality of life score on 6th post-operative month showed no significant difference between both the groups (p > 0.05). Level V dissection in MRND is associated with higher incidence and greater severity of shoulder dysfunction. AAS and SPADI score are useful tools in post operative follow up of shoulder dysfunction. NCS helps in the detection of neuropathy and to determine its severity. Early rehabilitation promotes long term recovery. [ABSTRACT FROM AUTHOR]

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Objective: To develop posterior reduction forceps for atlantoaxial dislocation and evaluate the preliminary clinical application of this forceps in assisting simple posterior screw-rod system reduction and fixation in the treatment of irreducible atlantoaxial dislocation. Methods: Based on the posterior atlantoaxial screw-rod system, posterior reduction forceps was developed to assist simple posterior screw-rod system for the treatment of irreducible atlantoaxial dislocation. From January 2021 to October 2022, 10 cases with irreducible atlantoaxial dislocation were treated with this technique. The Japanese Orthopaedic Association (JOA) score was applied before and after surgery to evaluate the neurological status of the patient, and the Atlanto-dental interval (ADI) was measured before and after surgery to evaluate the atlantoaxial reduction. X-ray and CT were performed to evaluate internal fixation, atlantoaxial sequence and bone graft fusion during regular follow-up. MRI was performed to evaluate the status of atlantoaxial reduction and spinal cord compression after surgery. Results: All 10 patients were successfully operated, and there were no complications such as spinal nerve and vascular injury. Postoperative clinical symptoms were significantly relieved in all patients, and postoperative JOA score and ADI were significantly improved compared with those before surgery (P < 0.05). Conclusions: The developed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation to avoid the release in anterior or posterior approach and reduce the difficulty of surgery. The preliminary results of this technique are satisfactory and it has a good application prospect. [ABSTRACT FROM AUTHOR]

Accurate knowledge of anatomy is an important prerequisite for carrying out interventions and achieving good results. In particular, risks and complications can be avoided if perils are known. It is important to recognize and clearly communicate transitional anomalies in the bony spine. Curved structures must be correctly interpreted during fluoroscopy and projection on the two-dimensional screen. When injecting facet joints, attention must be paid to the small intra-articular volume and possible communication between the joint space and adjacent spaces. Controlling the depth of the needle in the spinal canal is important for interlaminar injections; an oblique setting can be helpful here. Exact knowledge of possible courses of the neighboring arteries is necessary in order to avoid intra-arterial injections and thus potentially serious complications. Finally, knowledge about the nerves is important in order to be able to place targeted injections in the right place. [ABSTRACT FROM AUTHOR]

This study investigated the effects of cilostazol on motor dysfunction, spinal motor neuron abnormalities, and schwannopathy in rats with diabetes. Diabetes mellitus (DM) was induced in rats via femoral intravenous streptozotocin (STZ) injection (60 mg/kg). After successful DM induction, cilostazol was administered on day 15 via oral gavage (100 mg/kg/day) for 6 weeks until sacrifice. Behavioral assays, including motor function, were performed weekly. The sciatic nerve, L5 spinal cord, and spinal ventral root were collected to evaluate the expression of the glial fibrillary acidic protein (GFAP), myelin protein zero (P0), and choline acetyltransferase (ChAT) by immunofluorescence and Western blotting. DM rats displayed decreased running speeds, running distances, and toe spread but increased foot pressure. In addition, loss of non-myelinating Schwann cells and myelin sheaths was observed in the sciatic nerve and L5 spinal ventral root. Reduced numbers of motor neurons were also found in the L5 spinal ventral horn. Cilostazol administration significantly potentiated running speed and distance; increased hind paw toe spread; and decreased foot pressure. In the sciatic nerve and L5 spinal ventral root, cilostazol treatment significantly improved non-myelinated Schwann cells and increased myelin mass. ChAT expression in motor neurons in the spinal ventral horn was improved, but not significantly. Cilostazol administration may protect sensorimotor function in diabetic rats. [ABSTRACT FROM AUTHOR]

Objective: Ankylosing spondylitis (AS), an autoimmune disease, often leads to lower cervical spine fractures, with the potential for severe spinal nerve damage even from low-energy injuries. The optimal treatment approach remains debated. Methods: A retrospective study involved 17 AS patients with lower cervical spine fractures who received anterior cervical fixation. Most presented cervicothoracic or thoracolumbar kyphosis, with 11 exhibiting neurological deficits. Patient characteristics, clinical data, visual analog scale (VAS), complications, and nerve recovery were analyzed. Results: No postoperative neurological deterioration occurred. All cases experienced complete fusion of fractures during the follow-up period. Preoperative VAS significantly decreased at 3 days and 3 months post-surgery. Of the 11 patients with preoperative neurological deficits, approximately 54.5% showed improvement post-surgery. No complications were reported, such as esophageal fistula, wound infection, or fixation failure. Conclusion: Anterior internal fixation is a possible treatment for AS-related lower cervical fractures. This approach ensures satisfactory spinal stability and neurological recovery with proper cranial traction and external fixation post-surgery. Our findings demonstrate that this surgical method is safe and effective. [ABSTRACT FROM AUTHOR]

Background: Cavernous hemangiomas are vascular malformations formed by groups of dilated sinusoids, organized in channels with a single layer of endothelium. Cavernous hemangiomas represent only 3% of all intradural lesions, and of these 5-12 % correspond to spinal cord lesions and those of the cauda equina are rare. Clinical case: A 57 years-old male patient is presented, without history of radiotherapy, who showed low back pain and contracture of the dorsal and paraspinal muscle during 6 months, evaluated in another hospital and diagnosed with a lumbar disc herniation, he was managed with analgesics and physiotherapy for two months, however the theraphy failed, the symptoms worsened and dysesthesias appeared in the gluteal and perianal region, with reduction of strength in both legs with predominance in the left leg, as well bladder sphincter dysfunction. A simple magnetic resonance imaging of the lumbosacral spine was performed, revealing an intraspinal and intradural lesion at the L1-2 level. He was diagnosed with cauda equina syndrome and surgery was carried out. After surgery the patient presented clinical improvement and resolution of symptoms. During follow-up in the outpatient clinic, one month after surgery, the patient was able to walk independently and is currently asymptomatic. The pathological anatomy result reported a cavernous hemangioma. Conclusions: Cavernous hemangiomas of the cauda equina are rare, and when they are associated with a cauda equina syndrome, early surgery is recommended like the first option treatment to avoid permanent neurological injury. [ABSTRACT FROM AUTHOR]

Background: Comorbid chronic neuropathic pain (NPP) and anxio-depressive disorders (ADD) have become a serious global publichealth problem. The SLIT and NTRK-like 1 (SLITRK1) protein is important for synaptic remodeling and is highly expressed in the amygdala, an important brain region involved in various emotional behaviors. We examined whether SLITRK1 protein in the amygdala participates in NPP and comorbid ADD. Methods: A chronic NPP mouse model was constructed by L5 spinal nerve ligation; changes in chronic pain and ADD-like behaviors were measured in behavioral tests. Changes in SLITRK1 protein and excitatory synaptic functional proteins in the amygdala were measured by immunofluorescence and Western blot. Adeno-associated virus was transfected into excitatory synaptic neurons in the amygdala to up-regulate the expression of SLITRK1. Results: Chronic NPP-related ADD-like behavior was successfully produced in mice by L5 ligation. We found that chronic NPP and related ADD decreased amygdalar expression of SLITRK1 and proteins important for excitatory synaptic function, including Homer1, postsynaptic density protein 95 (PSD95), and synaptophysin. Virally-mediated SLITRK1 overexpression in the amygdala produced a significant easing of chronic NPP and ADD, and restored the expression levels of Homer1, PSD95, and synaptophysin. Conclusion: Our findings indicated that SLITRK1 in the amygdala plays an important role in chronic pain and related ADD, and may prove to be a potential therapeutic target for chronic NPP-ADD comorbidity. [ABSTRACT FROM AUTHOR]

The application of ultrasound (US) in pain medicine has been a rapidly growing field since the 2000s. Musculoskeletal injections, peripheral nerve blocks, and neuraxial injections under US guidance have been acknowledged for managing chronic pain. Although many studies on US-guided pain procedures have been published, there needs to be a classification system to evaluate which image device, the US or fluoroscopy, is clinically and technically better in various pain interventions. Therefore, this narrative review introduces the classification system for the US-guided pain procedures according to their clinical and technical outcomes and designates US-guided pain procedures into one of the four categories by reviewing previous prospective randomized comparative trials. [ABSTRACT FROM AUTHOR]