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International Journal of Molecular... Feb 2023The use of stimulation of peripheral nerves to test or treat various medical disorders has been prevalent for a long time. Over the last few years, there has been... (Review)
Review
The use of stimulation of peripheral nerves to test or treat various medical disorders has been prevalent for a long time. Over the last few years, there has been growing evidence for the use of peripheral nerve stimulation (PNS) for treating a myriad of chronic pain conditions such as limb mononeuropathies, nerve entrapments, peripheral nerve injuries, phantom limb pain, complex regional pain syndrome, back pain, and even fibromyalgia. The ease of placement of a minimally invasive electrode via percutaneous approach in the close vicinity of the nerve and the ability to target various nerves have led to its widespread use and compliance. While most of the mechanism behind its role in neuromodulation is largely unknown, the gate control theory proposed by Melzack and Wall in the 1960s has been the mainstay for understanding its mechanism of action. In this review article, the authors performed a literature review to discuss the mechanism of action of PNS and discuss its safety and usefulness in treating chronic pain. The authors also discuss current PNS devices available in the market today.
Topics: Humans; Chronic Pain; Transcutaneous Electric Nerve Stimulation; Electric Stimulation Therapy; Peripheral Nerves; Pain Management; Chronic Disease
PubMed: 36901970
DOI: 10.3390/ijms24054540 -
Stem Cells and Development Feb 2017Despite a substantially increased understanding of neuropathophysiology, insufficient functional recovery after peripheral nerve injury remains a significant clinical... (Review)
Review
Despite a substantially increased understanding of neuropathophysiology, insufficient functional recovery after peripheral nerve injury remains a significant clinical challenge. Nerve regeneration following injury is dependent on Schwann cells, the supporting cells in the peripheral nervous system. Following nerve injury, Schwann cells adopt a proregenerative phenotype, which supports and guides regenerating nerves. However, this phenotype may not persist long enough to ensure functional recovery. Tissue-engineered nerve repair devices containing therapeutic cells that maintain the appropriate phenotype may help enhance nerve regeneration. The combination of gene and cell therapy is an emerging experimental strategy that seeks to provide the optimal environment for axonal regeneration and reestablishment of functional circuits. This review aims to summarize current preclinical evidence with potential for future translation from bench to bedside.
Topics: Animals; Cellular Microenvironment; Genetic Therapy; Humans; Nerve Regeneration; Peripheral Nerves; Stem Cell Transplantation; Tissue Engineering
PubMed: 27960587
DOI: 10.1089/scd.2016.0188 -
The Journal of Hand Surgery, European... Jun 2024From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace.... (Review)
Review
From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace. Whether performing primary neurorrhaphy or managing multiple large nerve defects, the modern nerve surgeon has an extensive range of tools, techniques and choices available to them. Continuous innovation in surgical equipment and technique has enabled the maturation of autografting as a gold standard for reconstruction and welcomed the era of nerve transfer techniques all while bioengineers have continued to add to our armamentarium with implantable devices, such as conduits and acellular allografts. We provide the reader a concise and up-to-date summary of the techniques available to them, and the evidence base for their use when managing nerve transection including current use and applicability of nerve transfer procedures.
Topics: Humans; Nerve Transfer; Peripheral Nerve Injuries; Peripheral Nerves; Nerve Regeneration; Neurosurgical Procedures
PubMed: 38603601
DOI: 10.1177/17531934241242002 -
Muscle & Nerve Apr 2020Peripheral nerve injury remains a major cause of morbidity in trauma patients. Despite advances in microsurgical techniques and improved understanding of nerve... (Review)
Review
Peripheral nerve injury remains a major cause of morbidity in trauma patients. Despite advances in microsurgical techniques and improved understanding of nerve regeneration, obtaining satisfactory outcomes after peripheral nerve injury remains a difficult clinical problem. There is a growing body of evidence in preclinical animal studies demonstrating the supportive role of stem cells in peripheral nerve regeneration after injury. The characteristics of both mesoderm-derived and ectoderm-derived stem cell types and their role in peripheral nerve regeneration are discussed, specifically focusing on the presentation of both foundational laboratory studies and translational applications. The current state of clinical translation is presented, with an emphasis on both ethical considerations of using stems cells in humans and current governmental regulatory policies. Current advancements in cell-based therapies represent a promising future with regard to supporting nerve regeneration and achieving significant functional recovery after debilitating nerve injuries.
Topics: Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Recovery of Function; Stem Cell Transplantation
PubMed: 31725911
DOI: 10.1002/mus.26760 -
Acta Neurochirurgica Sep 2017From time to time it is thoughtful and productive to review a medical field and reflect upon what are the major issues that need to be addressed and what is being done... (Review)
Review
From time to time it is thoughtful and productive to review a medical field and reflect upon what are the major issues that need to be addressed and what is being done to do so. This review article is not meant to be all-inclusive but rather focuses on four evolving areas in the field of peripheral nerve disorders and treatments: (1) nerve surgery under ultrasound guidance using a new ultra-minimally invasive thread technique; (2) evolving magnetic resonance imaging (MRI) and ultrasound imaging techniques that are helping to both diagnose and treat a variety of peripheral nerve problems including entrapment neuropathies, traumatic nerve injuries, and masses arising from nerves; (3) promoting recovery after nerve injury using electrical stimulation; and (4) developing animal models to reproduce a severe nerve injury (neurotmetic grade in continuity) that requires a surgical intervention and repair. In each area we first describe the current challenges and then discuss new and emerging techniques and approaches. It is our hope that this article will bring added attention and resources to help better address peripheral nerve problems that remain a challenge for both patients and physicians.
Topics: Animals; Humans; Nerve Regeneration; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 28500566
DOI: 10.1007/s00701-017-3203-3 -
Radiographics : a Review Publication of... 2019Evaluation of traumatic peripheral nerve injuries has classically been based on clinical and electrophysiologic criteria. US and MRI have been widely used for... (Review)
Review
Evaluation of traumatic peripheral nerve injuries has classically been based on clinical and electrophysiologic criteria. US and MRI have been widely used for morphologic assessment of nerve injury sites and concomitant lesions. In the past few years, morphologic MR neurography has significantly increased its clinical applications on the basis of three-dimensional or two-dimensional images with and without fat-suppression techniques. However, these sequences have a major drawback: absence of pathophysiologic information about functional integrity or axonal flow of peripheral nerves. In this scenario, functional MRI techniques such as diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI) can be used as a complementary tool in initial evaluation of peripheral nerve trauma or in assessment of trauma undergoing surgical repair. These approaches provide not only morphologic but also functional information about extent and degree of nerve impairment. Functional MR neurography can also be applied to selection, planning, and monitoring of surgical procedures that can be performed after traumatic peripheral nerve injuries, such as neurorrhaphy, nerve graft, or neurolysis, as it provides surgeons with valuable information about the functional status of the nerves involved and axonal flow integrity. The physical basis of DWI and DTI and the technical adjustments required for their appropriate performance for peripheral nerve evaluation are reviewed. Also, the clinical value of DWI and DTI in assessment of peripheral nerve trauma is discussed, enhancing their potential impact on selection, planning, and monitoring of surgical procedures employed for peripheral nerve repair. Online supplemental material is available for this article. RSNA, 2019.
Topics: Humans; Magnetic Resonance Imaging; Peripheral Nerve Injuries; Peripheral Nerves; Postoperative Complications
PubMed: 30735470
DOI: 10.1148/rg.2019180112 -
Biofabrication Mar 2018After many decades of biomaterials research for peripheral nerve regeneration, a clinical product (the nerve guide), is emerging as a proven alternative for relatively... (Review)
Review
After many decades of biomaterials research for peripheral nerve regeneration, a clinical product (the nerve guide), is emerging as a proven alternative for relatively short injury gaps. This review identifies aspects where 3D printing can assist in improving long-distance nerve guide regeneration strategies. These include (1) 3D printing of the customizable nerve guides, (2) fabrication of scaffolds that fill nerve guides, (3) 3D bioprinting of cells within a matrix/bioink into the nerve guide lumen and the (4) establishment of growth factor gradients along the length a nerve guide. The improving resolution of 3D printing technologies will be an important factor for peripheral nerve regeneration, as fascicular-like guiding structures provide one path to improved nerve guidance. The capability of 3D printing to manufacture complex structures from patient data based on existing medical imaging technologies is an exciting aspect that could eventually be applied to treating peripheral nerve injury. Ultimately, the goal of 3D printing in peripheral nerve regeneration is the automated fabrication, potentially customized for the patient, of structures within the nerve guide that significantly outperform the nerve autograft over large gap injuries.
Topics: Animals; Humans; Mice; Nerve Regeneration; Peripheral Nerves; Printing, Three-Dimensional; Rats; Tissue Engineering; Tissue Scaffolds
PubMed: 29570458
DOI: 10.1088/1758-5090/aaaf50 -
Radiographics : a Review Publication of... 2016Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR)... (Review)
Review
Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR) imaging include higher soft-tissue resolution, cost effectiveness, portability, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently. US can be performed on patients who are not eligible for MR imaging. Metallic implant artifacts are usually not problematic. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Any abnormal findings can be easily compared with the contralateral side. The published literature has shown that US has demonstrated clinical utility in patients with suspected peripheral nerve disease by guiding diagnostic and therapeutic decisions as well as by confirming electrodiagnostic findings. Common indications for upper extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, and tumor. US of the upper extremity is most commonly performed to evaluate carpal and cubital tunnel syndrome. It is important for the radiologist or sonographer to have a detailed knowledge of anatomy and specific anatomic landmarks for each nerve to efficiently and accurately perform an examination. The goal of this article is to introduce readers to the basics of US of the peripheral nerves of the upper extremity with a focus on the median, ulnar, and radial nerves. Common sites of disease and the location of important anatomic landmarks will be reviewed.
Topics: Arm; Humans; Magnetic Resonance Imaging; Median Nerve; Peripheral Nerve Injuries; Peripheral Nerves; Peripheral Nervous System Diseases; Radial Nerve; Ulnar Nerve; Ultrasonography
PubMed: 26963456
DOI: 10.1148/rg.2016150088 -
Neurosurgery Clinics of North America Oct 2014Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve... (Review)
Review
Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve or over the painful area with the goal of modulating neuropathic pain. The selection of appropriate candidates for this therapy hinges on skillful application of inclusion and exclusion criteria, psychological screening, and an invasive screening trial. Patients with significant improvement in pain severity and pain-related disability during the trial are considered candidates for implantation of a permanent system. As with other implanted devices for neuromodulation, risks of mechanical failures, infection, and neurologic complications exist.
Topics: Chronic Pain; Humans; Implantable Neurostimulators; Neuralgia; Neurosurgical Procedures; Peripheral Nerves
PubMed: 25240665
DOI: 10.1016/j.nec.2014.07.003 -
Engineering topography: effects on nerve cell behaviors and applications in peripheral nerve repair.Journal of Materials Chemistry. B Aug 2021There have been extensive studies on the application of topography in the field of tissue repair. A common feature of these studies is that the existence of topological... (Review)
Review
There have been extensive studies on the application of topography in the field of tissue repair. A common feature of these studies is that the existence of topological structures in tissue repair scaffolds can effectively regulate a series of behaviors of cells and play a positive role in a variety of tissue repair and regeneration processes. This review focuses on the application of topography in the field of peripheral nerve repair. The integration of the topological structure and biomaterials to construct peripheral nerve conduits to mimic a natural peripheral nerve structure has an important role in promoting the recovery of peripheral nerve function. Therefore, in this review, we systematically analysed the structure of peripheral nerves and summarized the effects of topographic cues of different scales and shapes on the behaviors of nerve cells, including cell morphology, adhesion, proliferation, migration and differentiation. Furthermore, the application and performance of scaffolds with different topological structures in peripheral nerve repair are also discussed. This systematic summary may help to provide more effective strategies for peripheral nerve regeneration (PNR) and shed light on nervous tissue engineering and regenerative medicine.
Topics: Animals; Biocompatible Materials; Guided Tissue Regeneration; Humans; Nerve Regeneration; Peripheral Nerves; Tissue Engineering; Tissue Scaffolds
PubMed: 34302164
DOI: 10.1039/d1tb00782c