Sciatic neurotmesis and periostitis ossificans progressiva due to a traumatic/unexpected glass injury: a case report

( Berkay Yalçınkaya ),( Hasan Ocak ),( Ahmet Furkan Çolak ),( Levent Özçakar ) 영남대학교 의과대학 2024 Yeungnam University Journal of Medicine Vol.41 No.1

Peripheral nerves may be affected or injured for several reasons. Peripheral nerve damage can result from trauma, surgery, anatomical abnormalities, entrapment, systemic diseases, or iatrogenic injuries. Trauma and iatrogenic injuries are the most common causes. The ulnar, median, and radial nerves are the most injured nerves in the upper extremities, while the sciatic and peroneal nerves are the most injured nerves in the lower extremities. The clinical symptoms of peripheral nerve damage include pain, weakness, numbness/ tingling, and paresthesia. Therefore, early diagnosis and appropriate treatment of peripheral nerve injuries are crucial. If a peripheral nerve injury is left untreated, it can lead to severe complications and significant morbidity. The sciatic nerve is one of the most affected nerves. This nerve is generally injured by trauma and iatrogenic causes. Children are more susceptible to trauma than adults. Therefore, sciatic nerve injuries are observed in pediatric patients. When the sciatic nerve is damaged, pain, weakness, sensory loss, and gait disturbances can occur. Therefore, the diagnosis and treatment of sciatic nerve injuries are important to avoid unexpected consequences. Ultrasound can play an important role in the diagnosis of peripheral nerve injury and the follow-up of patients. The aim of this case report is twofold. First, we aimed to emphasize the critical role of ultrasonographic evaluation in the diagnosis of peripheral nerve injuries and pathologies. Second, we aimed to present this case, which has distinguishing features, such as the existence of periostitis ossificans progressiva with sciatic neurotmesis due to a traumatic glass injury.

Effective Parameters for Gait Analysis in Experimental Models for Evaluating Peripheral Nerve Injuries in Rats

Ivair Matias Júnior,Priscila Medeiros,Renato Leonardo de Freita,Hilton Vicente-César,José Raniery Ferreira Junior,Hélio Rubens Machado,Rafael Menezes-Reis 대한척추신경외과학회 2019 Neurospine Vol.16 No.2

Objective: Chronic constriction injury (CCI) of the sciatic nerve is a peripheral nerve injury widely used to induce mononeuropathy. This study used machine learning methods to identify the best gait analysis parameters for evaluating peripheral nerve injuries. Methods: Twenty-eight male Wistar rats (weighing 270±10 g), were used in the present study and divided into the following 4 groups: CCI with 4 ligatures around the sciatic nerve (CCI-4L; n=7), a modified CCI model with 1 ligature (CCI-1L; n=7), a sham group (n=7), and a healthy control group (n=7). All rats underwent gait analysis 7 and 28 days postinjury. The data were evaluated using Kinovea and WeKa software (machine learning and neural networks). Results: In the machine learning analysis of the experimental groups, the pre-swing (PS) angle showed the highest ranking in all 3 analyses (sensitivity, specificity, and area under the receiver operating characteristics curve using the Naive Bayes, k-nearest neighbors, radial basis function classifiers). Initial contact (IC), step length, and stride length also performed well. Between 7 and 28 days after injury, there was an increase in the total course time, step length, stride length, stride speed, and IC, and a reduction in PS and IC-PS. Statistically significant differences were found between the control group and experimental groups for all parameters except speed. Interactions between time after injury and nerve injury type were only observed for IC, PS, and IC-PS. Conclusion: PS angle of the ankle was the best gait parameter for differentiating nonlesions from nerve injuries and different levels of injury.

A guide to reducing adverse outcomes in rabbit models of sciatic nerve injury

Elisabeth Orozco,Koichi Masuda,Sameer B. Shah 한국실험동물학회 2021 Laboratory Animal Research Vol.37 No.2

Background Peripheral nerve damage can have debilitating consequences. Rabbit sciatic nerve transection models allow the effective evaluation of surgical repair strategies for large nerve gaps. Despite advantages in size, ease of handling, and functional utility, rabbits can suffer from a number of side effects that affect animal welfare and the quality of scientific inquiry. Such side-effects, which include pressure ulcers and traumatic damage to the foot, are primarily a consequence of insensitivity of the distal hindlimb following sciatic nerve injury. In this study, we present a number of methodologies for identifying, treating, and preventing unintended adverse effects in rabbit sciatic nerve injury models. Results First, we categorize pressure ulcers according to their severity and describe the deployment of a padded bandaging technique to enable ulcer healing. We also introduce a proactive bandaging approach to reduce the likelihood of pressure ulcer formation. Second, we define phenotypes that distinguish between foot injuries resulting from self-mutilation (autotomy) from those caused by incidental traumatic injury secondary to sensori-motor damage. Finally, we detail an effective strategy to reduce the usage of Elizabethan collars; through a gradual weaning protocol, their usefulness in preventing autotomy is retained, while their propensity to impede rabbit grooming and cause abrasion-injury to the neck region is minimized. Conclusions We suggest that application of these methods offer a practical and systematic approach to avoid adverse side effects associated with rabbit sciatic nerve damage, enabling improved animal welfare and scientific outcomes in a powerful nerve injury model.

Low-frequency pulsed electromagnetic field pretreated bone marrow-derived mesenchymal stem cells promote the regeneration of crush-injured rat mental nerve

Seo, NaRi,Lee, Sung-Ho,Ju, Kyung Won,Woo, JaeMan,Kim, BongJu,Kim, SoungMin,Jahng, Jeong Won,Lee, Jong-Ho Medknow PublicationsMedia Pvt Ltd 2018 Neural regeneration research Vol.13 No.1

<P>Bone marrow-derived mesenchymal stem cells (BMSCs) have been shown to promote the regeneration of injured peripheral nerves. Pulsed electromagnetic field (PEMF) reportedly promotes the proliferation and neuronal differentiation of BMSCs. Low-frequency PEMF can induce the neuronal differentiation of BMSCs in the absence of nerve growth factors. This study was designed to investigate the effects of low-frequency PEMF pretreatment on the proliferation and function of BMSCs and the effects of low-frequency PEMF pre-treated BMSCs on the regeneration of injured peripheral nerve using <I>in vitro</I> and <I>in vivo</I> experiments. In <I>in vitro</I> experiments, quantitative DNA analysis was performed to determine the proliferation of BMSCs, and reverse transcription-polymerase chain reaction was performed to detect S100 (Schwann cell marker), glial fibrillary acidic protein (astrocyte marker), and brain-derived neurotrophic factor and nerve growth factor (neurotrophic factors) mRNA expression. In the <I>in vivo</I> experiments, rat models of crush-injured mental nerve established using clamp method were randomly injected with low-frequency PEMF pretreated BMSCs, unpretreated BMSCs or PBS at the injury site (1 × 10<SUP>6</SUP> cells). DiI-labeled BMSCs injected at the injury site were counted under the fluorescence microscope to determine cell survival. One or two weeks after cell injection, functional recovery of the injured nerve was assessed using the sensory test with von Frey filaments. Two weeks after cell injection, axonal regeneration was evaluated using histomorphometric analysis and retrograde labeling of trigeminal ganglion neurons. <I>In vitro</I> experiment results revealed that low-frequency PEMF pretreated BMSCs proliferated faster and had greater mRNA expression of growth factors than unpretreated BMSCs. <I>In vivo</I> experiment results revealed that compared with injection of unpretreated BMSCs, injection of low-frequency PEMF pretreated BMSCs led to higher myelinated axon count and axon density and more DiI-labeled neurons in the trigeminal ganglia, contributing to rapider functional recovery of injured mental nerve. These findings suggest that low-frequency PEMF pretreatment is a promising approach to enhance the efficacy of cell therapy for peripheral nerve injury repair.</P>

말초신경손상에 의한 척수감각신경 세포의 감작

강석한,김찬,엄민숙,김진혁,김기순 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.1

Peripheral nerve injuries have been known to result in a chronic neuropathic pain characterized by symptoms of spontaneous burning pain, hyperalgesia, and allodynia. Recently it has been reported that the flexor reflex was greatly enhanced immediately after peripheral nerve section in the experimental animals. The persent study was underaken to investigte acute effects of the peripheral nerve injury on the sensitization of dorsal hom cells. After the sciatic nerve section, neither significant change was observed in the wind-up of WDR cells, nor wind-up was produced in the WDR cell that had not shown wind-up before the afferent nerve section. The A-fiber responses of WDR cells were not altered after section of the sciatic nerve. However, the C-fiber responses and after-discharge of the dorsal horn cell to imput signals started to increase in 2 hours after the nerve section. In 70% of experimental animals, the nerve section-induced increments in the WDR cell activities were abolished after topical application of 2% lidocaine to the proximal end of cut sciatic nerve. After pretreatemnt of the experimental animals with a NMDA receptor blocker, MK-801, the C-fiber response and after-discharge of the dorsal horn cell well not changed by the sciatic nerve section. These findings suggest that peripheral injury induces the sensitization of dorsal horn cells of the spinal cord and that signals from the proximal stump is essential for maintenance of the sensitization, which was mediated by NMDA receptors.

Hyaluronic Acid Promotes the Peripheral Nerve Regeneration in the Experimental Rabbit Model of Common Peroneal Nerve Crush Injury

Gonhyung Kim, Hye-Ran Gong, Seok Hwa Choi 충북대학교 동물의학연구소 2012 Journal of Biomedical and Translational Research Vol.13 No.1

This study demonstrated that hyaluronic acid (HA) accelerated peripheral nerve regeneration after crush injury to the common peroneal nerve in an experimental rabbit model. Ten male New Zealand White rabbits, weighing 1.8 to 2.0 kg, were used in this study. After creating the nerve crush model in every right leg, rabbits were divided into two groups. Animals in group A received application of HA into the area surrounding the crushed nerve, and group B was the sham control. Electrophysiological assessment was performed every week. After 10 weeks, nerve histological examination, muscle weight and muscle histology were used to evaluate regeneration of the injured common peroneal nerve. No differences in electrophysiological assessment were observed between the two groups. In peripheral nerve histology, myelinated nerve fibers were observed more frequently and less connective tissue was observed in the crushed nerve of group A. Fewer muscle degenerative changes, such as fibrosis, atrophy, and centrally located myonuclei, were detected in group A than in group B. In conclusion, HA could become a potential neuroprotective agent for improvement of peripheral nerve regeneration after crush injury.

Hyaluronic Acid Promotes the Peripheral Nerve Regeneration in the Experimental Rabbit Model of Common Peroneal Nerve Crush Injury

Hye-Ran Gong,최석화,김근형 충북대학교 동물의학연구소 2012 Journal of Biomedical and Translational Research Vol.13 No.1

This study demonstrated that hyaluronic acid (HA) accelerated peripheral nerve regeneration after crush injury to common peroneal nerve in experimental rabbit model. Ten male New Zealand White rabbits, weighing 1.8 to 2.0 kg, were used. After creating the nerve crushed model in every right legs, rabbits were divided into two groups. Group A was the HA application into surrounding crushed nerve area, and group B was the sham control. Electrophysiological assessment was estimated every weeks. After 10 weeks, nerve histological examination, muscle weight and muscle histology were used to evalutate the regeneration of injured common peroneal nerve. There were no differences in the electrophysiological assessment between two groups. The peripheral nerve histology showed that myelinated nerve fibers were observed more frequently and connective tissue was less in the crushed nerve of group A. Muscle degenerative changes such as fibrosis, atrophy and centrally located myonuclei were less detected in group A than group B. In conclusion, the HA could become a potential neuroprotective agent for improvement of peripheral nerve regeneration after the crush injury.

Review Article : Neural Ablation and Regeneration in Pain Practice

( Eun Ji Choi ),( Yun Mi Choi ),( Eun Jung Jang ),( Ju Yeon Kim ),( Tae Kyun Kim ),( Kyung Hoon Kim ) 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.1

A nerve block is an effective tool for diagnostic and therapeutic methods. If a diagnostic nerve block is successful for pain relief and the subsequent therapeutic nerve block is effective for only a limited duration, the next step that should be considered is a nerve ablation or modulation. The nerve ablation causes iatrogenic neural degeneration aiming only for sensory or sympathetic denervation without motor deficits. Nerve ablation produces the interruption of axonal continuity, degeneration of nerve fibers distal to the lesion (Wallerian degeneration), and the eventual death of axotomized neurons. The nerve ablation methods currently available for resection/removal of innervation are performed by either chemical or thermal ablation. Meanwhile, the nerve modulation method for interruption of innervation is performed using an electromagnetic field of pulsed radiofrequency. According to Sunderland’s classification, it is first and foremost suggested that current neural ablations produce third degree peripheral nerve injury (PNI) to the myelin, axon, and endoneurium without any disruption of the fascicular arrangement, perineurium, and epineurium. The merit of Sunderland’s third degree PNI is to produce a reversible injury. However, its shortcoming is the recurrence of pain and the necessity of repeated ablative procedures. The molecular mechanisms related to axonal regeneration after injury include cross-talk between axons and glial cells, neurotrophic factors, extracellular matrix molecules, and their receptors. It is essential to establish a safe, long-standing denervation method without any complications in future practices based on the mechanisms of nerve degeneration as well as following regeneration. (Korean J Pain 2016; 29: 3-11)

Neural Ablation and Regeneration in Pain Practice

최은지,최윤미,장은정,김주연,김태균,김경훈 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.1

A nerve block is an effective tool for diagnostic and therapeutic methods. If a diagnostic nerve block is successful for pain relief and the subsequent therapeutic nerve block is effective for only a limited duration, the next step that should be considered is a nerve ablation or modulation. The nerve ablation causes iatrogenic neural degeneration aiming only for sensory or sympathetic denervation without motor deficits. Nerve ablation produces the interruption of axonal continuity, degeneration of nerve fibers distal to the lesion (Wallerian degeneration), and the eventual death of axotomized neurons. The nerve ablation methods currently available for resection/removal of innervation are performed by either chemical or thermal ablation. Meanwhile, the nerve modulation method for interruption of innervation is performed using an electromagnetic field of pulsed radiofrequency. According to Sunderland’s classification, it is first and foremost suggested that current neural ablations produce third degree peripheral nerve injury (PNI) to the myelin, axon, and endoneurium without any disruption of the fascicular arrangement, perineurium, and epineurium. The merit of Sunderland’s third degree PNI is to produce a reversible injury. However, its shortcoming is the recurrence of pain and the necessity of repeated ablative procedures. The molecular mechanisms related to axonal regeneration after injury include cross-talk between axons and glial cells, neurotrophic factors, extracellular matrix molecules, and their receptors. It is essential to establish a safe, long-standing denervation method without any complications in future practices based on the mechanisms of nerve degeneration as well as following regeneration. (Korean J Pain 2016; 29: 3-11)

Neural Ablation and Regeneration in Pain Practice

Choi, Eun Ji,Choi, Yun Mi,Jang, Eun Jung,Kim, Ju Yeon,Kim, Tae Kyun,Kim, Kyung Hoon The Korean Pain Society 2016 The Korean Journal of Pain Vol.29 No.1

A nerve block is an effective tool for diagnostic and therapeutic methods. If a diagnostic nerve block is successful for pain relief and the subsequent therapeutic nerve block is effective for only a limited duration, the next step that should be considered is a nerve ablation or modulation. The nerve ablation causes iatrogenic neural degeneration aiming only for sensory or sympathetic denervation without motor deficits. Nerve ablation produces the interruption of axonal continuity, degeneration of nerve fibers distal to the lesion (Wallerian degeneration), and the eventual death of axotomized neurons. The nerve ablation methods currently available for resection/removal of innervation are performed by either chemical or thermal ablation. Meanwhile, the nerve modulation method for interruption of innervation is performed using an electromagnetic field of pulsed radiofrequency. According to Sunderland's classification, it is first and foremost suggested that current neural ablations produce third degree peripheral nerve injury (PNI) to the myelin, axon, and endoneurium without any disruption of the fascicular arrangement, perineurium, and epineurium. The merit of Sunderland's third degree PNI is to produce a reversible injury. However, its shortcoming is the recurrence of pain and the necessity of repeated ablative procedures. The molecular mechanisms related to axonal regeneration after injury include cross-talk between axons and glial cells, neurotrophic factors, extracellular matrix molecules, and their receptors. It is essential to establish a safe, long-standing denervation method without any complications in future practices based on the mechanisms of nerve degeneration as well as following regeneration.