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Those insults to the spinal cord which occur when ventral or dorsal roots are avulsed from the surface of the cord have been considered unfavourable with regard to both survival and axon regeneration of lesioned neurons. In this review, we describe the development of a surgical procedure aiming at a restoration of motor function after ventral root avulsion lesions. This development includes a series of investigations in animals, where an unexpected capacity for cell survival and axon regeneration of motoneurons after a cut lesion in the spinal cord was demonstrated and analyzed in great detail. Based on these findings, a surgical technique was tested, where avulsed ventral roots were replanted into the cord. After confirmation that such implanted roots could serve as a conduit for outgrowing motor axons in animals, the technique has been evaluated in a limited number of human cases of root avulsion lesions. We conclude that surgical intervention may indeed lead to return of motor function also in human cases of ventral root avulsion lesions. Interestingly, the procedure also seems to have an attenuating effect on the pain that develops in cases with a combined dorsal root avulsion. Lastly, we conclude that the cut lesion in the ventral part of the spinal cord, followed by axon regeneration in motoneurons may serve as a model for axon regeneration in the central nervous system.

Axon regeneration of spinal motoneurons following a lesion at the cord-ventral root interface