Tag Archives: spinal cord

‘Nerve bypass’ helps paralysed man move arm – Health – Harborough Mail

Published on Sunday 27 may 2012 21:32

Revolutionary surgery has given a paralysed man the ability to move his arms and hands again, it has been widely reported. the surgery, which made global news, has shown that rewiring nerves may allow surgeons to restore basic arm and hand control after serious spinal cord injuries.

A 71-year-old patient had been left paralysed from the neck down after the base of his neck was injured in a traffic accident. in a world first, surgeons were able to successfully bypass the injury site by grafting arm nerves from below the injury to nerves originating above the site of his injury. the surgery was given 23 months after his accident, and after several more months of therapy and training the man can handle objects, feed himself and even do basic writing.

This success story is clearly of massive significance to the man involved but also provides a blueprint for other surgeons around the country for how this technique may be applied in similar situations.

However, despite this fantastic success, it is important to bear in mind that this was an individual case, and it is not clear whether this technique will be equally successful in other patients with different types of spinal injuries or circumstances. the severity and location of the spinal cord injury are likely to be important factors in the success of this type of operation.

The research was detailed in a report written by researchers from the Division of Plastic and Reconstructive Surgery and the Department of Neurological Surgery at Washington University School of Medicine in St Louis, Missouri in the US. the case report was published in the peer-reviewed Journal of Neurosurgery. the report did not specify any sources of funding for the research.

This story received widespread media coverage and many papers reported on the restoration of function in a previously paralysed man. the coverage of the story was generally well balanced and reflected the case report accurately.

This case report described a surgical technique designed to restore nerve function to the arms and hands of a 71-year-old man who had been injured in a road traffic incident and left paralysed. the patient had experienced severing of the spinal cord at the top of his spine, causing him to be paralysed below the site of his injury. This meant the paralysis affected his arms and hands, as the nerves that control the arms are situated below the site of his spinal cord damage.

In this cutting-edge research surgeons created a ‘nerve bypass’ by grafting a working nerve originating in the spine above the injury site to the nerves in the lower arm originating below the injury site to restore some level of control lost following the injury.

Spinal cord injury (SCI) is devastating for the individuals affected and their families. Recovery from a complete SCI is rare, leaving most patients with significant permanent disability affecting the area below the site of the SCI. despite advances in understanding the processes that occur in short- and long-term SCI, corresponding advances in surgical techniques or applications to repair them have so far lagged behind.

Case reports are often published that share interesting developments or new techniques in a particular medical field, in this case surgery. Case reports provide a detailed description of the background of a single person and the treatment they received, along with how effective the particular treatment course has been. They do not necessarily reflect what will be seen in all patients treated with the same techniques in the future, but still provide a good insight into new or experimental techniques.

The right-handed 71-year-old man presented to a surgical department 22 months after he was injured in a motor vehicle accident. He had sustained a spinal injury to the lower part of his neck, called the C7 vertebra. This caused extensive paralysis below the injury site. the strength and mobility of his limbs were extensively assessed to see if surgery might be able to help. before surgery, he could flex his right wrist only weakly and could not pinch or grip with either hand. He could also not move his fingers on either hand.

A month after his initial assessment, the patient had surgery on both arms in a bid to restore some of the function of his hands. This was based on the concept that a working nerve originating in the spine above the injury site could be grafted onto the nerves in the lower arm to restore some of the control lost after the injury.  the ‘nerve transfer’ surgical technique involved taking a working nerve in the upper arm that originates from the C6 vertebral level (above the site of the injury), and joining it to the nerve system in the arm that originates from the C7 vertebra (the site of the injury).

This ‘nerve rewiring’ allowed working nerves above the spinal injury site to artificially connect with nerves below the injury site, which were previously unable to receive a signal due to the injury. Nerve transfer for spinal injuries is not new, but its application has so far been relatively limited.

After the surgery, the patient received continued hand physiotherapy to aid recovery and rehabilitation of the wasted hand muscles due to the injury.

During the operation, the surgeons stimulated the newly rewired nerves to check they were working and found that the nerve responses were essentially normal for the rewired nerves feeding the hand.

Eight months after the operation, the patient was able to move his left thumb and perform a pinching motion with his fingers and thumb in his left hand. the same increase in movement was achieved in the right hand after 10 months.

The authors report that he can now use his right hand to perform simple ‘hand to mouth movements’, and with his left hand he can feed himself and perform rudimentary writing activities. Recovery in the right hand has been slower than in the left.

Videos made available by the study group show that the man is now able to handle a ball with both hands, touch his fingers against his thumb in a pinching motion and feed himself. These were all activities he could not do before the surgery.

The researchers said that, to their knowledge, this is the first reported case of restored nerve control of the thumb and finger flexing movement after a spinal cord injury.

They also said the patient’s ‘function has improved significantly with his ability to feed himself’.

This case report represents the positive experience of a paralysed 71-year-old man who has been granted some manual control after a serious spinal injury to his neck. before surgery, he could only make minimal arm movements controlled by the nerves above his injury site, but no lifting or fine hand movements as they are controlled by nerves joined lower down the spine, below the site of his injury.

While the nerve transfer technique given to this patient is not new, its application is not widespread and the authors say this is the first time it has been used to successfully rewire the nerves supplying a hand. Furthermore, these gains occurred after surgery that was carried out 23 months after the injury was sustained. This suggests that surgery does not have to be performed immediately, and that it may be possible to carry out the technique in people who have been paralysed for some time.

In addition to the hugely significant benefits to the man involved, this success story has also created a blueprint for other surgeons around the country for how this technique may be applied in similar cases.

However, it is important to bear in mind the limitations of the surgery and the evidence of its effectiveness. This case report represents the experience of just one individual. Therefore, it is not clear whether this technique will be equally successful in other patients with different types of injuries or circumstances. the severity and location of the spinal cord injury are likely to be important in determining the relative success of this type of operation. Also, the level of strength and control achieved in this case did not appear to represent a complete restoration of arm function, although it was clearly still a massive improvement.

Analysis by Bazian. Edited by NHS Choices.

‘Nerve bypass’ helps paralysed man move arm – Health – Harborough Mail

Mesquite Trails second grader battles little-known spinal disorder

At first, the Braatens were just worried about Mackenzie running a high fever with no other symptoms. it was only when doctors gave the 7-year-old a chest X-ray, trying to rule out pneumonia, that anyone suspected anything more serious.

“her whole spine was so curved that they couldn’t see her left lung,” mother Chenoa Braaten said. “We never noticed her back. She has perfect posture.”

Mackenzie was diagnosed with scoliosis, but there was something more: fluid-filled sacs along her spine.

The lower part of Mackenzie’s brain was extending into the upper neck region of her spinal cord, which is known as a Chiari malformation. in turn, this caused spinal fluid to push its way into the cord, creating cavities known as syrinxes, a disorder known as syringomyella. The pressure on the cord can cause migraines, vision problems and even paralysis.

“if she would, like, go out and play with her cousins, she’d get major headaches,” Chenoa Braaten said.

Now 8 years old, Mackenzie had to miss the last month of 1st grade at Mesquite Trails Elementary School last year for emergency surgery to relieve some of the pressure on her spinal cord.

“I didn’t cry because I saw a lot of happy things at the hospital,” Mackenzie said, especially spending time with therapy dogs. her parents shed lots of tears, though, including her father, San Bernardino County Sheriff Sgt. Joe Braaten.

Since then, Mackenzie has had to wear a hard plastic back brace — and at times endure the ridicule of other children. She will also need major spinal surgery to correct the scoliosis when she’s 11.

“She’ll have this for the rest of her life,” Chenoa Braaten said. “She’ll have MRIs, the syrinx could come back, the Chiari (malformation) could come back.”

What frustrates Braaten, though, is that although Chiari malformations and syringomyella afflict as many people as multiple sclerosis, the disorders are much less known, even among doctors and specialists.

To help change things, Braaten is working with the American Syringomyelia and Chiari Alliance Project and trying to raise awareness of the condition among Californians and medical professionals.

“every time I put the brace on her, I want to cry,” Braaten said, tearing up. “I just want her to live a normal life.”

On Friday, the High Desert Sales Divas, a group of direct sales representatives, will donate 25 percent of all proceeds from a Quarter Mania event at Maverick Stadium to the American Syringomyelia and Chiari Alliance Project.

For more information on Chiari malformations and syringomyelia, visit ASAP.org or write Braaten at jcbraaten@gmail.com.

Mesquite Trails second grader battles little-known spinal disorder

What Are the Indications for Neck Surgery?

When a patient has neck surgery, the results are typically much better than for surgery of the low back. The reason is that the indications for surgery in the cervical spine are much better defined than they are for the lumbar region.

Allow me to explain why. a few decades ago, studies were done looking at neck surgery for patients who had neck pain that was not radiating into the arms. this is called axial neck pain and was due to arthritis in the joints of the neck. The results showed that outcomes for neck surgery for this reason were fairly poor. Patients did not get substantially better, and there was a high incidence of patients needing further surgery within a few years. So surgeons stopped doing it.

Due to this, the indications for neck surgery have been fairly well defined. here is a list of 4 indications for neck surgery.

1. fracture with instability. Patients who are involved in a car accident or a trauma may end up with broken bones in their neck and an unstable spinal column. these individuals need surgery in their cervical spine to prevent a spinal cord injury from occurring. One interesting reason for neck surgery is if the patient has no evidence of fracture on the imaging studies, but significant instability on the dynamic x-rays.

2. Herniated disc with radiculopathy- just because a patient has a herniated disc in their cervical spine with radiculopathy does not mean surgery is absolutely necessary. The term radiculopathy refers to when the herniated disc is pushing on a nerve root and causing pain down the arm in the sensory distribution of that nerve. if a person has muscle weakness from the nerves being pinched, that is more of an indication for surgery than simply having pain.

If a person tries conservative treatments for over 6 weeks and the pain is not getting better, surgery can be considered. The results of surgery for a pinched nerve in the neck are very good at over 90 to 95% success rates. if a person does have motor weakness as mentioned, it should not be watched for a very long time as if it doesn’t get better even if they technically perfect surgery is performed the motor weakness may not improve if there was too long of a wait before doing the surgery.

3. Spinal stenosis- this is a problem that comes on from arthritis causing bony overgrowth along with soft tissue overgrowth. these can result in multiple cervical nerve roots being pinched. because of this, a person may have significant pain going down one or both arms. Surgery for spinal stenosis is a quality of life decision, and is not mandatory. if the pain is treated nonoperatively and it simply is not getting better, as an elective decision then a decompression to free up the pinched nerves may help substantially.

4. Spinal cord compression- a person’s cervical spinal cord may be compressed for a number of reasons. There may be a tumor in the area that’s pushing on spinal cord. Also, the person may have a disorder called cervical myelopathy which may be a result of a large disc herniation that is calcified and is pushing on the spinal cord itself. The spinal cord can react against this and start to shrink. It is a good idea when the shrinking begins to happen to go ahead and have a decompression surgery as waiting too long may not reverse the resulting problem.

Neck surgery for these conditions often has a great outcome. The fact that neck surgery for pain that stays in the neck due to arthritis has been out of favor for a long time once again is the reason that the surgeries tend to do much better.

What Are the Indications for Neck Surgery?