Multiple lumbar roots neurotizations with the lower intercostal nerves. Preliminary clinical and electrophysiological results in a sheep model.
BACKGROUND
Neurotization of lumbar roots with lower intercostal nerves is a potential way to treat neurological deficits after spinal cord injury. The anatomical feasibility of such neurotizations in humans has already been reported. We propose to assess axonal regrowth after intercostal to lumbar neurotization in a sheep model.


METHODS
Ten sheep had a left T11-L2, T12-L3, and T13-L4 neurotization. In 5 sheep, a L1 level left hemisection of the spinal cord was performed. The sheep had clinical and electrophysiological monitoring with a 6 mon follow-up.


RESULTS
A flaccid paralysis with clinical asymmetry of the left abdominal wall was noted three months after surgery. This asymmetry improved in all the cases at the 6 mon follow-up. Motor potentials were detected without difficulty for the 3 neurotized nerves (L2, L3, and L4) in 5 sheep. In another sheep, motor potentials of the L3 root remained undetected. Eight sheep had postoperative complications responsible for the animals' death in 5 cases.


CONCLUSIONS
The current study demonstrates the technical feasibility of intercosto-lumbar neurotizations in a sheep model. We proved in all the animals--except in the case of 1 neurotized root--the ability of motor axon to regenerate through neurotization area down to the muscular effectors; however, we noted a high rate of postoperative complications in this animal model.
Vialle
Raphaël
R
Ecole de Chirurgie de l' Assistance Publique des Hôpitaux de Paris, Paris, France. raphael.vialle@trs.aphp.fr
Lozeron
Pierre
P
Loureiro
Maria-Carolina
MC
Tadié
Marc
M
D000818:Animals; D004594:Electrophysiology; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D016067:Nerve Transfer / Q000009:adverse effects / Q000379:methods*; D012756:Sheep; D013126:Spinal Nerve Roots / Q000601:surgery*