Scanning electron microscopic study of spinal arachnoid plaques

Calcified or ossified plaques within the spinal arachnoid membranes are often reported at autopsy and are occasionally incriminated as the cause of neurological symptoms in patients undergoing surgery. Histological studies of plaques have been done, but to our knowledge no studies using the scanning electron microscope (SEM) have been reported. In this study, portions of the spinal cord with plaques were removed from adult human cadavers in the dissecting laboratory and processed for SEM and energy-dispersive x-ray analysis (EDAX). The surfaces of the plaques appeared to be fibrous in some areas, studded with irregularly shaped projections or nodules in others, and smooth in yet other areas. Cells were seen in lacunae-like depressions on the surfaces of some plaques and EDAX revealed the presence of calcium on and near the cells. In some areas calcium and phosphorus were both detected, but not in the ratios seen in bone. No calcium was seen on smooth or fibrous areas. It is suggested that the plaques sampled in this study were composed largely of fibrous tissue encrusted in some areas with calcium salts. There was no evidence that any of the plaques contained bone.     

Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots

Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one‐third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one‐third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one‐third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1–L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots. Clin. Anat. 27:227–233, 2014. © 2013 Wiley Periodicals, Inc.     

与胸12,腰1椎骨对应的腰骶神经根的应用解剖

在２０具（男１６，女４）成人尸体上，对胸１２、腰１椎骨对应的蛛网膜下隙内脊髓节、脊神经前、后根进行了应用解剖学研究。结果胸１２椎骨多与腰２￣５脊髓节、胸１２￣腰５神经根对应；腰１椎骨与骶１￣尾脊髓节、腰１￣尾脊神经根对应，据此，损伤时利于定位诊断。腰１￣３脊神经根远侧段与腰４￣骶３的近侧段之间常有一定长度的重叠，重叠的长度供神经缝接参考。文内还对神经根排列位置，前、后根的数目、长度和外径等进行了观     

<Emphasis Type="Italic">In Vivo</Emphasis> Contrast-Enhanced MR Imaging of Direct Infusion into Rat Peripheral Nerves

Direct infusion, or convection-enhanced delivery (CED), into peripheral nerves may provide a method for delivering substances to the intrathecal space or specific fiber bundles entering the spinal cord. To better understand this potential delivery technique, we have characterized the extracellular transport of macromolecular agents from peripheral nerves to the spinal cord in magnetic resonance (MR) imaging studies. High-resolution dynamic contrast-enhanced MR imaging at 11.1 T was used to monitor and characterize in vivo the extracellular transport dynamics of Gd-DTPA–albumin tracer during CED into rat sciatic nerves. Extracellular tracers followed peripheral nerves towards the spinal cord and at vertebral levels L4 and L5 appeared to enter the cerebrospinal fluid and nerve roots. Uptake directly into spinal cord tissues (white and gray matter) appeared to be limited. Spatial distribution patterns within spinal cord regions depended on CED factors, including cannula placement, and underlying tissue structures including peripheral nerve branching and membrane structures at nerve root entry. The applied MR techniques allowed for visualization and quantification of tracer spread and distribution within the rat spinal cord region. The results show that CED into peripheral nerves provides an alternative route for delivering therapeutics to nerve roots and the intrathecal space surrounding the spinal cord.     

Reinnervation of the mammalian spinal cord after neonatal dorsal root crush

Summary In the adult mammal, nerve fibres do not regrow into the spinal cord after a dorsal root lesion. The elongation of dorsal root nerve fibres into the spinal cord of neonatal rats was examined: L4 and L5 dorsal roots were crushed in rat pups. After 3–6 months, the dorsal root-spinal cord junction was investigated morphologically in several long series of ultrathin cross-sections. In rats which had been operated on at birth (0–2 days old), axons from the lesioned roots could be followed into the CNS tissue of the spinal cord. In contrast to normal development, the usual short segment of CNS glia did not grow into the neonatally lesioned roots. Instead, the CNS-PNS border was located within the spinal cord. The nerve fibres, which were of normal diameter, had regrown across the PNS-CNS border and elongated further into the CNS environment of the spinal cord. In rats operated on at the end of the first postnatal week or later, the largest dorsal root nerve fibres were only half the size of those in unoperated animals and reinnervation of the spinal cord had not occurred. An astrocyte-dominated CNS segment had developed in these roots. The impact of an early neuronal lesion on the development of certain glia cells and their importance in the outcome of spinal cord reinnervation are discussed.     

Influence of bioresorbable, unsintered hydroxyapatite/poly-L-lactide composite films on spinal cord, nerve roots, and epidural space

The effect of forged unsintered hydroxyapatite/poly-L-lactide (u-HA/PLLA) composite films on spinal cord and nerve roots and its degradation behavior and osteoconductivity in epidural space were compared with those of calcined HA (c-HA)/PLLA and unfilled PLLA films. Partial laminectomy was performed on 20 rabbits, and u-HA/PLLA and PLLA films were implanted in the intervertebral space. Total laminectomy was performed on 30 rabbits to implant u-HA/PLLA, c-HA/PLLA, and PLLA films in both epidural and subcutaneous spaces. For up to 50 weeks, there were no histological changes in the spinal cord or nerve root, and no inflammatory cell infiltration into the epidural space around the films. The rate of decrease in viscosity average molecular weight of both composite films was initially higher than that of PLLA but eventually became lower, although there was no difference in the degradation behavior of the three films in either the epidural or subcutaneous spaces after 50 weeks. Scanning electron microscopic and energy-dispersive X-ray analysis indicated calcium phosphate deposits on the surface of composite films with new bone formation from 4 weeks. The u-HA/PLLA composite film therefore has good biocompatibility, osteoconductivity, and fast primary degradation rate, which may prove compatible with application to spinal surgery.     

大鼠桡神经钳夹伤后背根节和脊髓nNOS免疫阳性神经元的变化

目的研究大鼠桡神经钳夹伤后背根神经节(DRG)和脊髓nNOS免疫阳性神经元的变化,探讨NO是否参与大鼠桡神经钳夹伤后的DRG和脊髓水平的痛觉调制。方法用辣根过氧化物酶追踪大鼠桡神经的由来;大鼠桡神经钳夹伤结合免疫组化法,研究桡神经钳夹伤后DRG鄄和脊髓的nNOS免疫阳性结构变化。结果(1)大鼠桡神经的组成范围在C5～T1;(2)大鼠桡神经钳夹伤后,DRG内nNOS免疫阳性神经元的变化难以分析:脊髓后角nNOS免疫阳性结构数量减少、免疫强度下降。结论大鼠桡神经钳夹伤后,脊髓nNOS免疫阳性结构发生可塑性变化,NO在桡神经钳夹伤后的痛觉调制中有一定的作用。     

Segment length and root orientation in normal and sacrally attached spinal cords: A morphometric study

This study compares human spinal cord segment length and spinal nerve root orientation in normal and sacrally attached cords. The proportion of the total length of the mature normal spinal cord made up by individual segments varies little between C1 and T1. Between T2 and T6 it increases gradually to a maximum and decreases steadily from T7 to the caudal termination of the cord. The C1 and C2 roots run superolaterally from the cord to their intervertebral foramina. C3 runs almost horizontally. From C4 to T2 roots run progressively more caudally. At T3 and lower levels each root runs caudally in contact with the lateral cord margin before turning laterally to its intervertebral foramen. The pattern of variation in segment length of a sacrally attached cord resembles that in normal cords between upper cervical and lower thoracic levels. In the sacrally attached cord, segment length remains relatively unchanged between mid-thoracic and mid-lumbar levels and decreases rapidly caudal to L3. © 1993 Wiley-Liss, Inc.     

Blood flow in the sciatic nerve is regulated by vasoconstrictive and vasodilative nerve fibers originating from the ventral and dorsal roots of the spinal nerves

Anesthetized rats were subjected to repetitive electrical stimulation of either the ventral or dorsal root of the spinal nerves between the 11th thoracic and 2nd sacral spinal segments. The response of nerve blood flow (NBF) in the sciatic nerve was examined using laser Doppler flowmetry. For all nerve fibers stimulation was for a 10–30-s period at a supramaximal intensity. (1) Stimulation of the T11-L1 ventral roots produced an increase in mean arterial pressure (MAP) and a biphasic NBF response was comprised of an initial increase and a subsequent decrease. The initial increase was a passive vasodilation due to the increase in MAP, while the following decrease in NBF resulted from active vasoconstriction of the vasa nervorum due to the activation of sympathetic nerves innervating the sciatic vasa nervorum. (2) Stimulation of the ventral root of the L6 segment produced an increase in NBF, even though MAP decreased. This increase in NBF was apparently mediated by activation of parasympathetic cholinergic vasodilators, because the response was abolished by i.v. injection of atropine, a muscarinic cholinergic receptor antagonist. (3) Stimulation of the dorsal roots between the L3 and S1 segments produced an increase in NBF, independent of changes in MAP. This increase in NBF appeared to be mediated by activation of a calcitonin gene-related peptide (CGRP) containing afferent fibers innervating the vasa nervorum, because the response was abolished by topical application of hCGRP (8–37), a CGRP receptor antagonist. In conclusion, NBF in the sciatic nerve is regulated by: (1) sympathetic vasoconstrictors exiting the ventral roots of the spinal cord via the T11-L1 segments; (2) parasympathetic vasodilators exiting the ventral roots of the spinal cord via the L6 segment; and (3) afferent CGRP containing vasodilators entering the dorsal roots of the spinal cord via the L3-S1 segments.     

A novel extradural nerve transfer technique by coaptation of C4 to C5 and C7 to C6 for treating isolated upper trunk avulsion of the brachial plexus

The study aimed to demonstrate the feasibility of an extradural nerve anastomosis technique for the restoration of a C5 and C6 avulsion of the brachial plexus. Nine fresh frozen human cadavers were used. The diameters, sizes, and locations of the extradural spinal nerve roots were observed. The lengths of the extradural spinal nerve roots and the distance between the neighboring nerve root outlets were measured and compared in the cervical segments. In the spinal canal, the ventral and dorsal roots were separated by the dura and arachnoid. The ventral and dorsal roots of C7 had sufficient lengths to anastomose those of C6. The ventral and dorsal of C4 had enough length to be transferred to those of C5, respectively. The feasibility of this extradural nerve anastomosis technique for restoring C5 and C6 avulsion of the brachial plexus in human cadavers was demonstrated in our anatomical study     

腰神经根被膜的显微解剖学观察及其临床意义

为探讨神经根被膜的结构特点及其临床意义 ,本研究通过光镜及电镜对 10例 ( 2 0侧 )新鲜胎尸的共 10 0条腰段神经根和部分坐骨神经、腓总神经进行了显微解剖、组织学观察和比较。结果证明 ,神经根被膜与周围神经干被膜之间存在差异。腰段神经根的硬膜囊内段前、后根由很薄的软脊膜覆包 ,而各小束束膜为更薄的类似软脊膜的被膜包裹 ;硬膜外腔段神经根被它所带出的软脊膜、蛛网膜和硬脊膜包裹 ,被膜厚度随层次增加而增加。神经根的被膜与周围神经干被膜相比较薄且层次少 ,层与层之间的连接相对松散。上述结果提示 ,神经根被膜与周围神经干被膜相比 ,其韧性及抗张力能力相对较脆弱 ,存在着易受损伤的潜在因素 ,且抵抗炎性反应的化学刺激能力也差     

Heterotopic regeneration of peripheral nerve fibres into the subarachnoid space

Summary Within the spinal cord meninges of SJL/J mice afflicted with chronic relapsing experimental allergic encephalomyelitis for up to seven months postinoculation, networks of aberrant regenerated nerve fibres myelinated by Schwann cells have been observed. These P.N.S. elements are believed to have been derived from incoming sensory fibres from the spinal nerve roots which had been interrupted during acute stages of the disease. This phenomenon might also have been related to the occurrence of marked nerve fibre loss and gliosis within superficial tracts in the spinal cord. P.N.S. elements within the subarachnoid space were first apparent six weeks postinoculation, and were distributed around the entire spinal cord and tended to be more concentrated around meningeal blood vessels. Schwann cells associated with these fibres frequently contained centrioles and cilia and daughter Schwann cells apparently arose from parent cells already committed to axons.     

脊神经前根吻合重建脊髓损伤大鼠的股四头肌功能

背景：如何重建脊髓损伤肢体运动功能对截瘫患者具有重要的意义。 目的：探索利用脊髓损伤平面以上健存的脊神经前根与支配股四头肌的腰神经建立神经通路,恢复脊髓损伤后股四头肌的神经支配和肌收缩功能。 方法：对清洁级SD大鼠L₁神经根的前根与L3神经根的前根进行显微吻合。经一段时间(6个月)的轴突再生后,期望建立新的肌肉收缩功能。神经缝合后6个月,在破坏L₂ 脊髓节段前后,分别进行神经电生理检测,观察股四头肌神经支配情况。 结果与结论：在同侧L₂半切脊髓前后,电刺激移植神经干时可记录到股四头肌的收缩肌电图。在同侧L₂半切脊髓前后,电刺激L₁感觉根时可同样在股四头肌记录到肌电图。说明利用脊髓损伤平面以上健存的L₁神经根前根与L₃神经前根移植吻合能重建新的股四头肌神经支配反射通路,并使股四头肌低级反射中枢上移。     

脑源性神经营养因子在部分去传入猫脊髓背角的表达

为探讨脑源性神经营养因子在部分去传入猫脊髓背角的表达状况 ,对成年雄性家猫切除 L1 ～ L5 ,L7～ S2 背根节、保留L6 节及背根 ,术后分别存活 3、6、12 d,对 L6 节段脊髓进行脑源性神经营养因子免疫组织化学反应。结果表明 :正常时 ,阳性反应物主要分布在脊髓 I、II板层的神经终末、膨体与少量神经元胞体内。术后 3 d,术侧 II板层阳性神经终末和膨体密度开始减少 ,6d减少至高峰 ,到第 12 d时两者又均恢复到正常水平 ,而阳性神经元胞体的数量却无明显变化。作者认为 3 d、6d的减少主要与邻近背根节切除后 ,其神经纤维和膨体溃变有关 ;12 d时 ,保留的 L6 背根逐渐侧支出芽 ,且与靶细胞再建功能联系 ,故脑源性神经营养因子阳性神经纤维和膨体数均趋于恢复。说明脑源性神经营养因子既参与脊髓的正常生理功能 ,也与其损伤后的可塑性有关。     

Intradural anastomoses between the accessory nerve and the posterior roots of cervical nerves: their clinical significance.

This study was performed to identify the anastomoses between the accessory nerve and the posterior roots of cervical nerves below the level of C1 segment, and to evaluate their clinical significance. One hundred spinal cord sides of Koreans were studied under the surgical microscope. In order to trace the posterior root of a cervical nerve after anastomosis with the accessory nerve, or the bridging fibers between the accessory nerve and the cervical posterior roots, the accessory nerves with the posterior roots and the bridging fibers were stained with osmium tetroxide. The anastomosis was classified into five types, according to whether the accessory nerve and the cervical posterior root crossed each other, and also according to the site of the bridging fiber between them. The bridging fibers in the most common type of anastomoses were observed to connect the posterior roots of a cervical nerve with the spinal rootlet of the accessory nerve. The possibility that the motor fibers of accessory nerve from the spinal cord may innervate the trapezius muscle through the cervical nerve, was discussed.     

Nerve fibre regeneration across the peripheral–central transitional zone

Neurons cannot negotiate an elongation across the peripheral (PNS)–central nervous system (CNS) transitional zone and grow into or out of the spinal cord in the mature mammal. The astrocytic rich CNS part of the spinal nerve root is most effective in preventing regeneration even of nerve fibres from transplanted embryonic ganglion cells. Regeneration of severed nerve fibres into the spinal cord occurs when the transition zone is absent as in the immature animal. Before the establishment of a transition zone there is also new growth of neuronal processes from dorsal horn neurons distally to the injured dorsal root. Thus the experimental strategy to reestablish spinal cord to peripheral nerve connectivity has been to delete the transitional region and implant severed ventral or dorsal roots into the spinal cord. Dorsal root implantation resulted in reestablished afferent connectivity by new neuronal processes from secondary sensory neurons in the dorsal horn of the spinal cord extending into the PNS. The ability for plasticity in these cells allowed for a concurrent retention of their original rostral projection. Ventral root implantation into the spinal cord corrected deficit motor function. In a long series of experiments performed in different species, the functional restitution was demonstrated to depend on an initial regrowth of motor neuron axons through spinal cord tissue (CNS). These findings have led to the design of a new surgical strategy in cases of traumatic spinal nerve root injuries.     

In vitro release of immunoreactive substance P from putative afferent nerve endings in bovine pia arachnoid

The release of substance P-like immunoreactivity was examined using bovine pia arachnoid and its attendant blood vessels in vitro. At concentrations of 20,51, and 100 mM, potassium ions evoked the release of substance P-like immunoreactivity in a dose-dependent manner. The drug capsaicin released substance P at concentrations greater than 10(-8) M. Both potassium- and capsaicin-induced release were abolished by omitting calcium ions from the superfusion buffer. When subjected to separation by reverse phase high performance liquid chromatography, the superfusate from capsaicin perfused tissues contained a peak of immunoreactivity which migrated at the retention time corresponding to substance P. During basal and stimulated states, the percent endogenous substance P released ranged between 0.4-6.5 X 10(-2) and 1.3-11.6 X 10(-2) per minute, rates comparable to those previously reported by others using slices of dorsal horn or spinal cord segments. The immunoreactivity measurable in the conditioned buffer probably reflected release from afferent nerve endings in as much as most of the substance P immunoreactivity in pia arachnoid arises from trigeminal ganglia. Release of substance P, a cerebrovasodilating peptide from perivascular nerve endings in pia arachnoid suggests a possible role for substance P in the pathophysiology of disorders associated with pain of cerebrovascular origin.     

Distribution of Podoplanin-Expressing Cells in the Mouse Nervous Systems

Podoplanin is a mucin-type glycoprotein which was first identified in podocytes. Recently, podoplanin has been successively reported as a marker for brain and peripheral nerve tumors, however, the distribution of podoplanin-expressing cells in normal nerves has not been fully investigated. This study aims to examine the podoplanin-expressing cell distribution in the mouse head and nervous systems. An immunohistochemical study showed that the podoplanin-positive areas in the mouse peripheral nerve and spinal cord are perineurial fibroblasts, satellite cells in the dorsal root ganglion, glia cells in the ventral and dorsal horns, and schwann cells in the ventral and dorsal roots; in the cranial meninges the dura mater, arachnoid, and pia mater; in the eye the optic nerve, retinal pigment epithelium, chorioidea, sclera, iris, lens epithelium, corneal epithelium, and conjunctival epithelium. In the mouse brain choroid plexus and ependyma were podoplanin-positive, and there were podoplanin-expressing brain parenchymal cells in the nuclei and cortex. The podoplanin-expressing cells were astrocyte marker GFAP-positive and there were no differences in the double positive cell distribution of several portions in the brain parenchyma except for the fornix. The results suggest that podoplanin may play a common role in nervous system support cells and eye constituents.     

Regrowth of lesioned dorsal root nerve fibers into the spinal cord of neonatal rats

In postnatal rat pups the L4 and L5 dorsal roots were lesioned. After 3-6 months the spinal cord of the rats was subjected to tracing studies of regenerated dorsal root axons with transganglionically transported horseradish peroxidase (HRP) and immunohistochemistry with antibodies to calcitonin gene-related peptide (CGRP). In rats operated at birth (0-2 days old) HRP-filled profiles as well as CGRP staining were found in the outer lamina of the spinal cord dorsal horn. Signs of dorsal root nerve fiber regrowth in the spinal cord could not be found in rats which had been operated at the end of the first postnatal week or later.