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Progress in Neurological Surgery 2015Peripheral nerve stimulation (PNS) generally refers to stimulation of a named nerve via direct placement of a lead next to the nerve either via a percutaneous or open... (Review)
Review
Peripheral nerve stimulation (PNS) generally refers to stimulation of a named nerve via direct placement of a lead next to the nerve either via a percutaneous or open approach; in peripheral nerve field stimulation (PNFS), leads are subcutaneously placed to stimulate the region of affected nerves, cutaneous afferents, or the dermatomal distribution of the nerves which converge back to the spinal cord. Recently, there has been a renewed interest in using the PNS approach for many otherwise refractory pain conditions; however, PNFS appears to be more effective for the management of low back pain and therefore more attractive. Here we discuss procedural details of PNFS trial and implant, and provide scientific and clinical rationale for placing PNFS electrodes at a certain depth under the skin. We also summarize results of published studies on use of PNFS in the management of low back pain and list the criteria that are used for proper patient selection. Our experience and the published studies provide evidence that PNFS is a safe and well-tolerated pain control option for intractable pain conditions, including chronic low back pain. Notably, achieving efficacious pain relief relies on correct patient selection and the optimal placement of the leads, ensuring, in particular, a lead depth of 10-12 mm from the surface to maximize the target sensation (mediated by fast-adapting Aβ fibers) of PNFS, which is believed to be most effective for the pain relief.
Topics: Back Pain; Electric Stimulation Therapy; Electrodes, Implanted; Humans; Implantable Neurostimulators; Pain Management; Peripheral Nerves
PubMed: 26393502
DOI: 10.1159/000434666 -
Experimental Neurology Sep 2019Local application of exogenous agents with neurotrophic properties enhances the regenerative capacity of injured neurons, especially following reconstructions of long... (Review)
Review
Local application of exogenous agents with neurotrophic properties enhances the regenerative capacity of injured neurons, especially following reconstructions of long nerve gaps and delayed nerve repairs. Recent advances in biomaterials and biomedical engineering have provided options for the sustained and controlled release of macromolecules to the peripheral nerve. Here, we review five methods for delivering macromolecules to the peripheral nerve including mini-osmotic pumps, hydrogel-based delivery systems, nerve guidance conduits, electrospun fibers, and nerve wraps. In addition to controlling the release of bioactive macromolecules, the ease of clinical use and versatility in implantation at a variety of "real-world" anatomical locations are key factors in designing an ideal delivery system. The incorporation of both mechanical and biological cues into such devices also helps optimize these systems.
Topics: Animals; Biocompatible Materials; Drug Carriers; Drug Delivery Systems; Humans; Nerve Regeneration; Peripheral Nerves; Tissue Scaffolds
PubMed: 30176220
DOI: 10.1016/j.expneurol.2018.08.014 -
Bulletin of the Hospital For Joint... Jan 2017Peripheral nerve injuries following trauma present an ongoing challenge to the hand surgeon. This review presents an overview of the topic with a historical perspective.... (Review)
Review
Peripheral nerve injuries following trauma present an ongoing challenge to the hand surgeon. This review presents an overview of the topic with a historical perspective. Nerve anatomy and nerve injury classifications are discussed followed by a description of the biology of nerve regeneration. Methods used to bridge gaps in peripheral nerve repair are discussed in detail with a critical appraisal of the most recent literature. Recommendations for surgical treatment are formulated based on evidence-based medicine.
Topics: Animals; Evidence-Based Medicine; Humans; Nerve Regeneration; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Treatment Outcome
PubMed: 28214463
DOI: No ID Found -
Best Practice & Research. Clinical... Mar 2019A perineural catheter with a continuous infusion of local anesthetic is an excellent option for postoperative analgesia; however, its limitations include limited... (Review)
Review
A perineural catheter with a continuous infusion of local anesthetic is an excellent option for postoperative analgesia; however, its limitations include limited duration of action (i.e., 3-7 days) as well as a risk of infection and dislodgement. Furthermore, these blocks may cause dense sensory and motor blockades that under certain circumstances may not be ideal. There is novel evidence that ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) may serve as an alternative approach free of the limitations associated with peripheral nerve blocks. In this review, we discuss the evidence for pPNS on postoperative acute pain management. Subsequently, we briefly discuss additional alternatives to continuous peripheral nerve blocks, including cryoanalgesia and liposomal bupivacaine.
Topics: Analgesia; Catheters, Indwelling; Humans; Pain, Postoperative; Peripheral Nerves; Transcutaneous Electric Nerve Stimulation; Ultrasonography, Interventional
PubMed: 31272652
DOI: 10.1016/j.bpa.2019.02.002 -
Handchirurgie, Mikrochirurgie,... Feb 2024
Topics: Humans; Peripheral Nerve Injuries; Neurosurgical Procedures; Peripheral Nerves
PubMed: 38508201
DOI: 10.1055/a-2168-2239 -
Foot and Ankle Clinics Sep 2023Peripheral neuropathies of the foot and ankle can be challenging to diagnose clinically due to concomitant traumatic and nontraumatic or degenerative orthopedic... (Review)
Review
Peripheral neuropathies of the foot and ankle can be challenging to diagnose clinically due to concomitant traumatic and nontraumatic or degenerative orthopedic conditions. Although clinical history, physical examination, and electrodiagnostic testing comprised of nerve conduction velocities and electromyography are used primarily for the identification and classification of peripheral nerve disorders, MR neurography (MRN) can be used to visualize the peripheral nerves as well as the skeletal muscles of the foot and ankle for primary neurogenic pathology and skeletal muscle denervation effect. Proper knowledge of the anatomy and pathophysiology of peripheral nerves is important for an MRN interpretation.
Topics: Humans; Peripheral Nervous System Diseases; Ankle; Magnetic Resonance Imaging; Peripheral Nerves; Magnetic Resonance Spectroscopy
PubMed: 37536819
DOI: 10.1016/j.fcl.2023.04.003 -
The Journal of Hand Surgery Dec 2019Advanced imaging is increasingly used by upper extremity surgeons in the diagnosis and evaluation of peripheral nerve pathology. Ultrasound and magnetic resonance... (Review)
Review
Advanced imaging is increasingly used by upper extremity surgeons in the diagnosis and evaluation of peripheral nerve pathology. Ultrasound and magnetic resonance neurography (MRN) have emerged as the most far-reaching modalities for peripheral nerve imaging and often provide complimentary information. Technology improvements allow better depiction of the peripheral nervous system, allowing for more accurate diagnoses and preoperative planning. The purpose of this review is to provide an overview of current modalities and expected advances in peripheral nerve imaging with a focus on practical applications in the clinical setting. Ultrasound is safe, inexpensive, and readily available, and allows dynamic imaging with high spatial resolution as well as immediate evaluation of the contralateral nerve for comparison. It is primarily limited by its dependency on skilled operators and soft tissue contrast. The spatial evaluation of the perineural environment, fascicular echostructure, and nerve diameter are features of particular use in the diagnosis and treatment of nerve tumors, compressive lesions, and nerve trauma. Sonoelastrography has shown promise as a useful adjunct to standard sonographic imaging. MRN refers to the optimization of magnetic resonance image sequences and technology for visualization and contrasting nerves from surrounding structures. MRN provides excellent soft tissue contrast, depicts the entire nerve in 3 dimensions, allows for early evaluation of downstream muscle injury, and functions without operator dependency limits. Images provide details of nerve anatomic relationships, congruency, size, fascicular pattern, local and intrinsic fluid status, and contrast enhancement patterns, making MRN particularly useful in the setting of trauma, tumor, compressive lesions, and evaluation of brachial plexus injuries. Advances in MR volume and cinematic rendering software, magnet and coil technology, nerve-specific contrast media, and diffusion-weighted and tensor imaging will likely continue to expand the clinical application and indications for MRN.
Topics: Humans; Magnetic Resonance Imaging; Peripheral Nerves; Peripheral Nervous System Diseases; Ultrasonography
PubMed: 31585745
DOI: 10.1016/j.jhsa.2019.06.021 -
Experimental Neurology Sep 2016Compared to the central nervous system (CNS), peripheral nerves have a remarkable ability to regenerate and remyelinate. This regenerative capacity to a large extent is... (Review)
Review
Compared to the central nervous system (CNS), peripheral nerves have a remarkable ability to regenerate and remyelinate. This regenerative capacity to a large extent is dependent on and supported by Schwann cells, the myelin-forming glial cells of the peripheral nervous system (PNS). In a variety of paradigms, Schwann cells are critical in the removal of the degenerated tissue, which is followed by remyelination of newly-regenerated axons. This unique plasticity of Schwann cells has been the target of myelin repair strategies in acute injuries and chronic diseases, such as hereditary demyelinating neuropathies. In one approach, the endogenous regenerative capacity of Schwann cells is enhanced through interventions such as exercise, electrical stimulation or pharmacological means. Alternatively, Schwann cells derived from healthy nerves, or engineered from different tissue sources have been transplanted into the PNS to support remyelination. These transplant approaches can then be further enhanced by exercise and/or electrical stimulation, as well as by the inclusion of biomaterial engineered to support glial cell viability and neurite extension. Advances in our basic understanding of peripheral nerve biology, as well as biomaterial engineering, will further improve the functional repair of myelinated peripheral nerves.
Topics: Animals; Demyelinating Diseases; Humans; Myelin Sheath; Nerve Regeneration; Neuroglia; Peripheral Nerves
PubMed: 27079997
DOI: 10.1016/j.expneurol.2016.04.007 -
Journal of Artificial Organs : the... Dec 2022Autologous nerve grafting is the gold standard method for peripheral nerve injury with defects. Artificial nerve conduits have been developed to prevent morbidity at the... (Review)
Review
Autologous nerve grafting is the gold standard method for peripheral nerve injury with defects. Artificial nerve conduits have been developed to prevent morbidity at the harvest site. However, the artificial conduit regeneration capacity is not sufficient. A Bio 3D printer is technology that creates three-dimensional tissue using only cells. Using this technology, a three-dimensional nerve conduit (Bio 3D nerve conduit) was created from several cell spheroids. We reported the first application of the Bio 3D nerve conduit for peripheral nerve injury. A Bio 3D nerve conduit that was created from several cells promotes peripheral nerve regeneration. The Bio 3D nerve conduit may be useful clinically to treat peripheral nerve defects.
Topics: Humans; Peripheral Nerve Injuries; Nerve Regeneration; Peripheral Nerves; Prostheses and Implants; Autografts; Tissue Scaffolds
PubMed: 35970971
DOI: 10.1007/s10047-022-01358-9 -
European Journal of Neurology Aug 2023Hereditary spastic paraplegias (HSPs) are heterogenous genetic disorders. While peripheral nerve involvement is frequent in spastic paraplegia 7 (SPG7), the evidence of...
BACKGROUND AND OBJECTIVES
Hereditary spastic paraplegias (HSPs) are heterogenous genetic disorders. While peripheral nerve involvement is frequent in spastic paraplegia 7 (SPG7), the evidence of peripheral nerve involvement in SPG4 is more controversial. We aimed to characterize lower extremity peripheral nerve involvement in SPG4 and SPG7 by quantitative magnetic resonance neurography (MRN).
METHODS
Twenty-six HSP patients carrying either the SPG4 or SPG7 mutation and 26 age-/sex-matched healthy controls prospectively underwent high-resolution MRN with large coverage of the sciatic and tibial nerve. Dual-echo turbo-spin-echo sequences with spectral fat-saturation were utilized for T2-relaxometry and morphometric quantification, while two gradient-echo sequences with and without an off-resonance saturation rapid frequency pulse were applied for magnetization transfer contrast (MTC) imaging. HSP patients additionally underwent detailed neurologic and electroneurographic assessments.
RESULTS
All microstructural (proton spin density [ρ], T2-relaxation time, magnetization transfer ratio) and morphometric (cross-sectional area) quantitative MRN markers were decreased in SPG4 and SPG7 indicating chronic axonopathy. ρ was superior in differentiating subgroups and identifying subclinical nerve damage in SPG4 and SPG7 without neurophysiologic signs of polyneuropathy. MRN markers correlated well with clinical scores and electroneurographic results.
CONCLUSIONS
MRN characterizes peripheral nerve involvement in SPG4 and SPG7 as a neuropathy with predominant axonal loss. Evidence of peripheral nerve involvement in SPG4 and SPG7, even without electroneurographically manifest polyneuropathy, and the good correlation of MRN markers with clinical measures of disease progression, challenge the traditional view of the existence of HSPs with isolated pyramidal signs and suggest MRN markers as potential progression biomarkers in HSP.
Topics: Humans; Spastic Paraplegia, Hereditary; Peripheral Nerves; Peripheral Nervous System Diseases; Polyneuropathies; Magnetic Resonance Spectroscopy; Magnetic Resonance Imaging
PubMed: 37154411
DOI: 10.1111/ene.15841