The purpose of this study was to classify the spinal nerve compositions of the terminal branches of the lumbosacral plexus, providing data of their participating quantities. Twenty-five sides of the lumbosacral plexus extracted from Korean adult cadavers were used in this study. The iliohypogastric nerve was mostly arisen from L1 (88.2%, thickness L1 0.7 mm). The ilioinguinal nerve was arisen from only L1 (100%, thickness L1 0.6 mm). The genitofemoral nerve was commonly arisen from L1 and L2 (62.5%, thickness L1 0.6 mm, L2 0.7 mm). The lateral femoral cutaneous nerve was classified into 4 types, and the most common type was that L2 and L3 composed this nerve (56.0%, thickness L2 0.8 mm, L3 0.4 mm). The femoral nerve was classified into 2 types, and it was usually composed of L2, L3 and L4 (88.0%, thickness L2 1.4 mm, L3 2.7 mm, L4 2.3 mm). The obturator nerve was arisen from L2, L3 and L4 in all cases (100%, thickness L2 0.5 mm, L3 1.3 mm, L4 1.1 mm). The common fibular component of sciatic nerve was mostly arisen from L4, L5, S1 and S2 (84.0%, thickness L4 0.9 mm, L5 2.0 mm, S1 2.1 mm, S2 1.2 mm). The tibial component of sciatic nerve was mainly arisen from L4, L5, S1 and S2 (96.0%, thickness L4 0.9 mm, L5 1.9 mm, S1 2.2 mm, S2 1.9 mm). The superior gluteal nerve was commonly derived from L4, L5 and S1 (56.0%, thickness L4 0.7 mm, L5 1.1 mm, S1 0.9 mm). The inferior gluteal nerve was comprised of L5, S1 and S2 in several cases (54.2%, thickness L5 0.9 mm, S1 1.3 mm, S2 0.8 mm). The posterior femoral cutaneous nerve was composed of S1 and S2 in higher freqeuncy (40.0%, thickness S1 0.9 mm, S2 1.0 mm, S3 0.8 mm). The perforating cutaneous nerve was arisen from S2 and S3 in higher frequency (56.0%, thickness S1 0.7 mm, S2 0.9 mm, S3 1.1 mm). The pudendal nerve was derived from S3 in many cases (52.9%, thickness S3 1.5 mm). These anatomical results may be helpful to predict the spinal nerve root lesions of the lumbosacral plexus.
Adult ; Cadaver ; Femoral Nerve ; Humans ; Lumbosacral Plexus ; Obturator Nerve ; Pudendal Nerve ; Sciatic Nerve ; Spinal Nerve Roots ; Spinal Nerves

This study was carried out to evaluate the quantity of the nerve fiber of the terminal branches of the typical brachial plexus in the 6 sides of the Korean adults. The dorsal scapular nerve, which is derived from ramus of the brachial plexus, was comprised of C5 and participating nerve fiber was 355+/-180. The long thoracic nerve was composed of C5, C6 and C7, and was mainly originated from C6, and participating nerve fiber was 743+/-346. The nerves, which are branched out from trunk, nerve to subclavius muscle was composed of C5 and participating quantity was 242+/-71. The suprascapular nerve was comprised of C5 and C6, and the nerve fiber was mainly derived from C5 (1,942+/-505). The nerve, which is originated from proximal portion of the cord, the lateral pectoral nerve was constituted of C5, C6 and C7. The main component was C7 as the 2,917+/-785 nerve fiber. The medial pectoral nerve was made with C8 and T1. The main component was C8 as the 964+/-430 nerve fiber. The upper subscapular nerve was derived from C5 and C6. The nerve fiber was 1,179+/-92 in C5, mainly participated. The Lower subscapular nerve was constituted of C5, C6 and C7. C6 was the main component and contributing nerve fiber was 1,070+/-390 in C6, principal component. The thoracodorsal nerve was formed by C6, C7 and C8. The chief component was C7, contributed of 2,335+/-324. The nerves, which are came out from the distal portion of the cord, musculocutaneous nerve was derived from the C5, C6 and C7. The C6 was principal component, and was joined with 4,009+/-1,883. The median nerve was contributed from C5 to T1. The chief component was C7 added with 9,651+/-2,663. The ulnar nerve was composed of C7, C8 and T1. The C8 was the main component comprised of 10,075+/-1,473. The medial brachial and antebrachial cutaneous nerves was constituted of C8 and T1. In the both nerves, the main component was T1 participated with 1,752+/-390, 3,080+/-1,140 respectively. The radial nerve was composed of C5 to T1. The C7 was principal component added with 7,958+/-2,333. The axillary nerve was made up C5 and C6. In the nerve, the both spinal segments were similarly participated to the nerve. This results could be applied for the injuries and neurotization procedure of the terminal nerves of the brachial plexus.
Brachial Plexus ; Median Nerve ; Muscles ; Musculocutaneous Nerve ; Nerve Fibers ; Nerve Transfer ; Porphyrins ; Radial Nerve ; Spinal Nerves ; Thoracic Nerves ; Ulnar Nerve

BACKGROUND: Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (alpha2delta) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the alpha2delta subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. METHODS: For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the alpha2delta subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. RESULTS: There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the alpha2delta subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. CONCLUSIONS: Up-regulation of the alpha2delta subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injury.
Acetone ; Animals ; Blotting, Western ; Calcium Channels ; Cold Temperature ; Diagnosis-Related Groups ; Ganglia, Spinal ; Hyperalgesia ; Organic Chemicals ; Peripheral Nerve Injuries ; Peroneal Nerve ; Polyenes ; Postoperative Period ; Rats ; Spinal Nerve Roots ; Spinal Nerves ; Sural Nerve ; Up-Regulation

Variations of spinal nerue compositions, which giue rise to the variable motor and sensory component, occured at the terminal branches of brachial plexus. This study performed to investigate the spinal nerve compositions of the main terminal branches of the brachial plexus in 32 sides of Korean adults. The main terminal branches contained the musculocutaneous, median, ulnar, radial and axillary nerves. The obtained results were as follows. The spinal nerve compositions of musculocutaneous nerve appeared as two types. The most frequent type was composed of C5, C6 and C7 at 75.0%. The mean diameter of C5 and C6 was 1.68+/-0.21 mm and 1.66+/-0.40 mm, respectively. The median nerve appeared as two types. The most frequent type was composed of C6, C7, C8, T1 components at 87.5%. The mean diameter of C7 was the thickest at 2.64+/-0.48 mm and C5 was most thin at 0.28+/-0.04 mm. The ulnar nerve appeared as four types. The most frequent type was comprised with C7, C8 and T1 at 75.0%. In the mean diameter, C8 was the thickest with 2.64+/-0.57mm and T1 was most thin with 0.06+/-0.56 mm. The radial nerve appeared as four types. The most frequent type was comprised from C5 to T1 at 43.7%. In the mean diameter, C7 was the thickest at 2.70+/-0.52 mm. The axillary nerve appeared as two types. The frequentest type was comprised with C5, C6 and C7 at 56.2%. In the mean diameter, C6 was the thickest at 1.73+/-0.56 mm. From the obtained results, spinal nerve compositions of the main terminal branches of the brachial plexus were more variable than the description of the anatomic textbook.
Adult ; Brachial Plexus* ; Humans ; Median Nerve ; Musculocutaneous Nerve ; Radial Nerve ; Spinal Nerves ; Ulnar Nerve

BACKGROUND: Although ramicotomy (division of the rami communicantes of the thoracic sympathetic ganglia) is a selective and physiological surgical method for essential hyperhidrosis, it has some problems such as higher recurrence rates and the different surgical results among the patients and between left and right sides in the same individual. As one of the factors that are related to the differences in surgical result and recurrences, we investigated the anatomical variations of the rami communicantes. The purpose of this study is to help develop new surgical methods to decrease surgical differences among the patients or between the left and right sides of the same individual and recurrence rates in the clinical application of ramicotomy. MATERIAL AND METHOD: We dissected 118 thoracic sympathetic chains in 59 adult Korean cadavers (male: 33, female: 26) to examine the anatomical variations of the rami communicantes from the second to the fourth thoracic sympathetic ganglia that have major components innervating to the hands. After the dissection of bilateral thoracic sympathetic chains, we compared the anatomy of left and right sides and examined the anatomical variations of rami communicantes. RESULT: The number and variation of communicating rami connecting the spinal nerves and the second sympathetic thoracic ganglion were much larger than lower levels. There was considerably less variability in the anatomy of the rami communicantes at successive levels. Among the 59 cadavers dissected, only 14.3% (9/59) had similar anatomy of thoracic sympathetic chains at both sides. As the components related to the essential palmar hyperhidrosis, intrathoracic nerve of Kuntz from the second thoracic sympathetic ganglion to the first intercostal nerve or brachial plexus were observed in 55.9% (66/118). The incidence of descending rami communicates from the second thoracic sympathetic ganglion to the third intercostal nerve and from the third thoracic sympathetic ganglion to the fourth intercostal nerve were 49.2% (58/118) and 28.0% (33/118). And the incidence of ascending rami communicates from the third thoracic sympathetic ganglion to the second intercostal nerve and from the fourth thoracic sympathetic ganglion to the third intercostal nerve were 6.8% (8/118) and 3.4% (4/118), respectively. CONCLUSION: Based on the various anatomical evidences of the rami communicantes from this study, only the ramicotomy at the third sympathetic ganglion level is insufficient for the treatment of the essential palmar hyperhidrosis to decrease the difference of surgical results and recurrences. When one is planning to perform the ramicotomy for the essential palmar hyperhidrosis, it is advantageous to divide the intrathoracic nerve of Kuntz on the second rib and the descending or ascending rami communicantes on the third and the fourth ribs as well as all the communicating rami from the third sympathetic ganglion.
Adult ; Brachial Plexus ; Cadaver ; Female ; Ganglia, Sympathetic* ; Ganglion Cysts ; Hand ; Humans ; Hyperhidrosis* ; Incidence ; Intercostal Nerves ; Recurrence ; Ribs ; Spinal Nerves

The aim of this study was to propose new more reliable peripheral nerve transection model to overcome the defect of the traditional sciatic axotomy model by specifically transecting L5 spinal nerve just after emerging from the intervertebral foramen and confining analysis area to the L5 spinal segment. The adult male Sprague-Dawley rats, weighing 300~350 g at the time of surgery, were used for the experiments. Four different experimental groups were used. 1. Sciatic nerve transection (Sc-Tx) group: transect the sciatic nerve in the popliteal fossa where it divided into the common peroneal nerve and tibial nerve. 2. L5 spinal nerve transection (L5-Tx) group: L5 spinal nerve was specifically transected. 3. Suture (Su) group: L5 spinal nerve was transected and immediately sutured. 4. Control group: the same surgical procedure with L5 spinal nerve transection group was performed except for the excision of L5 spinal nerve. To distinguish L5 motoneurons from the other level ones, the animals were received the retrograde tracer, FluoroGold into the axotomized proximal nerve stump. Serial coronal frozen sections at 40 microm thick through the L4 to L6 spinal segment was performed and the resultant total number of sections was about 180. Approximate serial 50 sections (approximately 2 mm) could be considered as the L5 segment based on the number of the fluorescent signals (above 20). L5 spinal segment could be differentiated from L4 and L6 segment based on their morphological characteristics under Cresyl violet stain. In L5-Tx group, at 2 and 4 weeks post-transection, the number of L5 spinal motoneurons was reduced by 8%. Meanwhile, Sc-Tx and Su groups showed no statistically notable changes. In this study, the authors could propose more reliable peripheral nerve axotomy model than the conventional sciatic nerve axotomy model by specifically transecting L5 spinal nerve and confining the investigating area within the L5 spinal segment.
Adult ; Animals ; Axotomy ; Benzoxazines ; Frozen Sections ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peroneal Nerve ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; Spinal Nerves ; Sutures ; Tibial Nerve ; Viola

The aim of this study was to propose new more reliable peripheral nerve transection model to overcome the defect of the traditional sciatic axotomy model by specifically transecting L5 spinal nerve just after emerging from the intervertebral foramen and confining analysis area to the L5 spinal segment. The adult male Sprague-Dawley rats, weighing 300~350 g at the time of surgery, were used for the experiments. Four different experimental groups were used. 1. Sciatic nerve transection (Sc-Tx) group: transect the sciatic nerve in the popliteal fossa where it divided into the common peroneal nerve and tibial nerve. 2. L5 spinal nerve transection (L5-Tx) group: L5 spinal nerve was specifically transected. 3. Suture (Su) group: L5 spinal nerve was transected and immediately sutured. 4. Control group: the same surgical procedure with L5 spinal nerve transection group was performed except for the excision of L5 spinal nerve. To distinguish L5 motoneurons from the other level ones, the animals were received the retrograde tracer, FluoroGold into the axotomized proximal nerve stump. Serial coronal frozen sections at 40 microm thick through the L4 to L6 spinal segment was performed and the resultant total number of sections was about 180. Approximate serial 50 sections (approximately 2 mm) could be considered as the L5 segment based on the number of the fluorescent signals (above 20). L5 spinal segment could be differentiated from L4 and L6 segment based on their morphological characteristics under Cresyl violet stain. In L5-Tx group, at 2 and 4 weeks post-transection, the number of L5 spinal motoneurons was reduced by 8%. Meanwhile, Sc-Tx and Su groups showed no statistically notable changes. In this study, the authors could propose more reliable peripheral nerve axotomy model than the conventional sciatic nerve axotomy model by specifically transecting L5 spinal nerve and confining the investigating area within the L5 spinal segment.
Adult ; Animals ; Axotomy ; Benzoxazines ; Frozen Sections ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peroneal Nerve ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; Spinal Nerves ; Sutures ; Tibial Nerve ; Viola

PURPOSE: To determine the relationship between change in the expression of the p75 neurotrophin receptor (NTR) and transient receptor potential vanilloid 1 (TRPV1) after a spinal nerve injury with time. MATERIALS AND METHODS: The L5 and L6 spinal nerve of the rats were cut unilaterally. The spinal cord and dorsal root ganglion (DRG) were subjected to immunohistochemistry for p75 NTR and TRPV1. RESULTS: The immunoreaction (IR) for p75 NTR in the neuronal cytoplasm was persistently lower on the ipsilateral L5 and L6 DRG but higher in the satellite cells and fibers. The colocalization between p75 NTR and TRPV1 was increased temporarily in the L4 DRG in both sides. In the spinal cord, p75 NTR-IR decreased temporalily in the ipsilateral dorsal horn of the L4-L6 level and had recovered at 28 days after injury. CONCLUSION: These results show that a differential change in the expression of p75 NTR and TRPV1 is related to the different functional recovery of the sensory and motor system, and that increased colocalizations between p75 NTR and TRPV1 in a non-injured DRG might be related to the development of neuropathic pain after a peripheral nerve injury.
Animals ; Cytoplasm ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Horns ; Immunohistochemistry ; Neuralgia ; Neurons ; Peripheral Nerve Injuries ; Rats* ; Receptor, Nerve Growth Factor* ; Spinal Cord* ; Spinal Nerve Roots* ; Spinal Nerves*

An effect of D-phenylalanine on the pain inhibitory mechanism of prolonged electrical stimulation of the peripheral nerve was studied in decerebrate cats and spinal cats. The response of spinal neurons was elicited either by electrical stimulation of the ipsilateral common peroneal nerve and tibial nerve. The single-unit activity of motor neurons which represent the flexion reflex was recorded from a filament of ventral rootlet divided from either the L7, S1 or S2 ventral root, and activity of dorsal horns cells was recorded with a microelectrode at the lumbosacral cord The conditioning stimuli which provocate the pain inhibitory mechanism of the common peroneal or tibial nerve was applied with repetitive, low frequency (2Hz), at a suprathreshold intensity for C fiber, for 30-45 minutes. The results of the experiment are summarized as follows: 1. Applying conditioning stimuli produced a powerful inhibition of the responses which was provocated by noxious stimuli in either the decerebrate or the spinal cat without any statistical difference, and this effect can be observed for 15 minutes after the cessation of the conditioning stlmuli 2. This response was reversed completely by systemic injection of a specific opiate antagonist, naloxone. It suggests that the conditioning stimulus of the peripheral nerve can produce the endogenous opiate related pain inhibitory effect as the spinal mechanism. 3. The conditioning stimuli can produce the analgesic effect by means of supression of the activity of the dorsal horn cell which was related to the pain response in the decerebrate cat. The same result could be observed in flexion reflex. 4. D-phenylalanine, a putative inhibitor of carboxypeptidase which degradates the endogenous opiate-enkephalin, was studied in this experiment under the hypothesis that D-phenylalanine will emphasize or prolongate the action of enkephalin. But, intravenously injected D-phenylalanine did not potentiate the inhibitory effect of the conditioning stimuli of the peripheral nerve. From the above result, it is speculated that the electrical stimulation of the peripheral nerve is directly mediated by an endogenous opiate related analgesia, and the site of the analgesic action resides mainly in spinal cord level. But these data could not support the gypothesis that antinociceptive effect of D-phenylalanine results frm the potentiation of endogenously released enkephalin.
Analgesia* ; Animals ; Cats* ; Electric Stimulation ; Enkephalins ; Horns ; Microelectrodes ; Motor Neurons ; Naloxone ; Nerve Fibers, Unmyelinated ; Neurons ; Peripheral Nerves* ; Peroneal Nerve ; Posterior Horn Cells ; Reflex ; Spinal Cord ; Spinal Nerve Roots ; Tibial Nerve

Six patients with twenty histologically proven neurilemmomas of the extremities were studied using magnetic resonance(MR) imaging. The size, number, signal intensity on spin-echo T1WI(TR 500-650ms/TE 14-25ms)and gradient -echo (TR 200-600ms/TE 14-20ms; flip angle 25-30)image, enhancement pattern, detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were analyzed. The masses ranged from 1 to 12cm in longitudinal diameter and originated from the median nerve, ulnar nerve, sciatic nerve, radial nerve, and tibial nerve. All the nerve tracts except for those of 5 lesions, which could not be detected due to their small diameter, were visualized as low intensity tubular structures. All visible nerve tracts were situated along the periphery of the lesion and this finding was considered to be specific for neurilemmona. All neurilemmomas were isointense with the surrounding muscle on spin-echo T1WI and hyperintense on gradient-echo image. After a GD-DTPA injection, all masses showed moderate or marked enhancement and more prominent inhomogeneity than that on nonenhanced scan. In 19 out of 20 lesions(95%), a low signal intensity capsule surrounding the masses could be seen. Four of the six patients showed multiple masses, which was unusual as neurilemmoma usually arises as a solitary mass. In conclusion, the MR findings, especially the eccentric location of the mass lesion from the nerve of origin and the presence of a capsule, were useful in making a diagnosis of neurilemmoma of the extremity and that multiple neurilemmomas were not uncommon.
Diagnosis ; Extremities* ; Gadolinium DTPA ; Humans ; Median Nerve ; Neurilemmoma* ; Radial Nerve ; Sciatic Nerve ; Tibial Nerve ; Ulnar Nerve