Carl Kao's Surgical Procedures in Ecuador

[Wise Young]

Dr. Carl Kao is a neurosurgeon who is offering a combination therapy. He is willing to travel to various places in the United States and see people. He operates in a clinic in Ecuador. From the description of various people who have visited him, he offers the following therapies that are often combined:
• decompressive/untethering surgery
• implantation of a sural nerve (which presumably provides Schwann cells that serve as a bridging environment for axonal growth and also cells that remyelinate the axons)
• omentum transposition (which apparently differs from the pedicled omentum that Dr. Harry Goldsmith uses in that he uses local blood vessels to provide the flow) to revascularize the injury area
• exercise program (exercises for different parts of the body, as well as boots and other devices that he recommends for specific situations)
• 4-aminopyridine to increase the excitability of the spinal cord in the post-operative period.

See Birde's topic on Carl Kao's procedures in the Cure Forum (http://carecure.org/forum/showthread.php?t=13657)

[This message was edited by Wise Young on August 06, 2001 at 01:40 PM.]

[Wise Young]

http://www.runningbear.com/main/Ed/text/urls/Dr.CarlKao.html

[Wise Young]

hospital in Ecuador that Kao works out of...Clinica Primavera
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http://www.clinicalaprimavera.com/ (click on Bienvenido) Everything is in Spanish and the English version doesn't seem to work, however if you bookmark the site and go to: and put in what you want translated (spanish to english) it will work.

Note (from Wise): For some reason, the [url="http://www.clinicalaprimavera.com"]www.clinicalaprimavera.com (http://babel.altavista.com[/URL) site does not work for my browser but other people might be able to gain access to it.

[Birde]

http://www.clinicalaprimavera.com/espanol/index.htm

[Wise Young]

Thanks, Birde, the new link works for me.

[Birde]

PHONE: 202-362-6421 FAX: 301-388-0994 ADDRESS: 3801 Connecticut Ave., N.W.,Suite 100 Washington D.C. 20008

[overtheline3]

hi there dr.young,what do you think about this surgery?in your terms,not docter terms,will his surgery affect us in any way from something else that comes along?how or is he getting those axons to grow out of the injury site?just getting bowel,blatter and sexual fuctions would be worth the money,and if things are so positive with his surgerys how come he isnt teaching other docters his process?you would think this would go through the fda in a blink of a eye,but hes not even trying,why?thanks a ton for your help,jeff pike

[Wise Young]

I hesitate to express my personal opinion on clinical trials because I really would prefer that people judge the therapies for themselves and that I provide facts rather than judgments concerning the trials. But I do want people to start discussing the trials. So, here goes.

In my opinion, Karl Cao is a very good neurosurgeon. I have known him for over 20 years and continue to be impressed by his skill, compassion, and honesty. He is a gifted and very experienced surgeon. I like the fact that he charges minimally for his work and the reasonable way in which he is presenting the results of his work. I have seen videos of his surgery and have known perhaps a dozen people he has operated on. I have not heard of any disasters and think that he is circumspect in his claims. Many of the cases that he has operated on are very complex and the patients have done well.

My understanding of his surgical procedure is as follows. He does a laminectomy to expose the spinal cord and does meticulous removal of any scar tissue and tethering that he sees. If the patient has a syringomyelic cyst in the spinal cord, he opens the cyst through the midline, implants the sural nerve (a sensory nerve in the leg) into the cyst. He then places an omentum transplant onto spinal cord which, I believe, prevents adhesion between the spinal cord and dura (a common complication of spinal surgery). He uses muscle fascia (the membrane covering muscles) to extend the dura so that it can accomodate the extra-bulk of the omentum (other neurosurgeons use artificial or cadaveric dura). He has special exercises that he has people do. In addition, he gives them 4-AP during the rehabilitation.

This appears to be a reasonable procedure and one that will benefit people who have compression and/or tethering of the spinal cord. If a person does not have compression, tethering, or a cyst in the spinal cord, I don't think that surgery would be warranted. There is little data from either animal or human experience suggesting that a peripheral nerve transplant would improve function. On the other hand, there is quite a bit of data indicating the decompression, untethering, and removal of adhesions may restore function even many years after injury, as well as collapse syringomyelic cysts. I find his use of the omentum graft to be innovative and think that it very likely helps. There is no convincing evidence that omentum transplants restore function but I think that the concept that it reduces scarring is very attractive. I also think that his use of muscle fascia to expand the dura is a very good idea.

Many other surgeons do decompression and detethering surgery. I know some people who have been through such procedures in the United States and Europe. In general, I have found patient satisfaction with these procedures in the U.S. to be lower than with Carl Kao. This was quite surprising to me. I think that the Tijuana Clinic that does shark embryo transplants may be using some of the techniques that Carl Kao uses but I think that patient satisfaction with Carl Kao is higher. Several overseas centers do omentum transplants but I have met some people who have been dissatisfied with the followup care.

I do want to emphasize the anecdotal nature of the above information. I would feel more comfortable with the situation if he were operating in the U.S. and published his experience. There is a history of antagonism between Carl Kao and the neurosurgical community. This may be one of the reasons why he operates in Ecuador. At the same time, it is clear that the costs of surgery and care is much lower in Ecuador.

I hope that his helps.

Wise.

[overtheline3]

dr.young,thanks so much for your help,i come on line to listen to you and others about what is going on,other then that i hate this computer more then anything,i cant sit still but have to in a way.I sent my x-rays and mri's to dr.kao this weekend to look at,you brought up about having tethering,compression or cyst,should i ask my docter here in san deigo that did my surgery about these things?i just know he is really negative about anything that could help me,he sits there and tells my mom and me that there will be help for me when there is to many poeple on mars and all of the different colleges he talks at and how much he knows,its just really a nightmare to me even talking to him.I hope you understand iam trying to learn day by day about this(oct 99 complete-7)thank-you jeff pike

[Birde]

http://runningbear.com/main/Ed/text/Ecuador/Surgery-1.html ****pictures of Ed's operation at the end of the page click on the next button and the 2cnd set of pictures will pop up. http://runningbear.com/main/Ed/text/Ecuador/Clinic-Inside-1.html ***pictures of the inside of the clinic

[BirdeR]

DETAILS ON JIM'S SURGERY-FRIDAY, AUGUST 24 (12HOURS) 1) removal of existing bone stimulater, rods, hooks, and screws from back. 2) laminectomy T6-T12 inclusive total 7 levels. 3) transpedicle anterior vertebretomy to remove bone compression in front of spinal cord until flat at T10 level. 4) bilateral forminotomy at T10 to decompress the nerve roots. 5) bilateral lateral gutter bone fusion. 6) microsurgical intradural release of arachnoid adhesions and evacuation of spinal cord cavity 4.5 cm. long at T7-T10 levels. 7) implantation of 15 fascicles of sural nerve together with dissociated Schwann cells into spinal cord cavity. 8) closure of pia over the implants with 7-0 Prolene thus retain the implants within the spinal cord. 9) suture fixation of a piece of omentum to the spinal cord and both sides of dura. 10) dural graft autologous fascia lata. 11) Jim completed (as do all the patients) 13 hyperbaric oxygen therapy sessions following the surgery each lasted 2.5 hours each. (1 session per day). ************************************************** *********** MEDICATIONS THAT JIM IS ON OR WILL BE ON: 1) Proviron, (testosterone) 2 tabs. before breakfast each day for 6 months. 2) Yohimbine 5.4 mg., 2 tabs. before sleep at night each day for 1 year. 3) Viagra 100mg., 1 tab. as needed 4) Urecholine 25 mg., 1 tab 3x a day before meals for aprox. 6-8 months. 5) Dibenzylene 10 mg., 1 tab. 3x a day before meals for aprox. 6-8 months. 6) 4-AP from Mr. Greg Dent who will decide along with Dr. Kao on the exact dosage. ************************************************** ***********JIMS BEGINING EXERCISE PROGRAM 1) begining 9/8: continue range of motion exercises at least 2x a day every day on both legs (as shown to us). 2) begining 9/14: begin to stand in standing frame/table (as was shown to us) 1hr. in AM and 1 hr. in PM. (at least). 3) begining 9/21: begin iliopsoas exercises , (with equipment shown to us), against 35-40 lbs. weight (as shown to us). Start at 1hr. a day (1/2 hr. per leg). May work up from that. 4) begining 9/28: begin leg exercises in face up position, (with equipment shown to us), against 30lbs. weight (to start) (as shown to us). 2 hours a day (1 hr. per leg). May work up from that.

[overtheline3]

hi there dr.young,what is this surgery doing that poeple are able to stand up in a matter of a couple of weeks with just leg braces that look like they only go up to your calfs?and it seems like in the last 3 months or so that every thing has slowed down,that nothing is coming up about trails or new discoverys,i use to here breaking news every week or promising stuff?just curious,thanks jeff

[Wise Young]

jeff, it is hard to say for sure but I believe that the recovery of function that we are seeing from Dr. Kao's surgery is restoration of function of existing connections. It is occurring too fast for regeneration and possibly remyelination. However, we should not rule out the latter possibility since Dr. Kao is transplanting Schwann cells through the peripheral nerve graft to the injury site. Certainly decompression and untethering have both been reported to restore function to the same extent by other surgeons (for example, this has long been reported by Hank Bohlman). U.S. surgeons have been traditionally reluctant to operate on chronic spinal cord injury because there is a tendency for readhesion and scarring. Also, many surgeons have been burned by loss of function after they have operated. I must say that I am impressed by the recent spate of recoveries that have been reported by people from our forums that have gone to Ecuador.

In India, where I spent 7 days touring eight spinal cord injury centers, a number of Indian neurosurgeons have shared experiences (and I saw the patients) that are similar. For example, in Coimbature (in Southern India), one of the most experienced neurosurgeons in India operated on a patient just one day before I arrived. This patient was apparently a "complete" injury with flaccid lower limbs and no reflexes, voluntary movement, or sensation below T11. A team of neurosurgeons, including one from Japan, examined the patient. If I remember correctly, the patient was more than two weeks after injury and had some compression of the cord. In any case, by the time I arrived, they had re-examined the patient at 24 hours after decompression. The patient reports some movement of one leg and sensation in both legs. This was reported by the team of neurosurgeons who had really no expectation of any recovery and was doing the surgery as a demonstration of how to decompress the cord at that level.

Regarding the dearth of news concerning spinal cord injury advances, there are many reasons. The first and foremost is the lack of any news reports of anything else but the attacks on the World Trade Center and Pentagon, as well as the economic aftermath. The second is that we are just about 6 weeks from the Society for Neuroscience meeting where there will be a flood of new work. This may be the calm before the storm. The third is that most scientists (like myself) are just stunned by the events of the past several weeks and have been trying to deal with the unfolding tragedies.

I will post more in the Life Forum concerning the effects of the tragic events on scientific activities around the world.

Wise.

[overtheline3]

thanks dr.young for your reply,jeff

[Rbyrd2531]

Dr Young,
what tests would show whether there is tethering or compression in the spinal cord?
MRI or CT scan I suppose? Or would it have to be a neurospect scan?
Thanks and very glad you are safely home:)

Russ Byrd

[Vike]

How does a person find out if there may be compression in the cord? Would a MRI help? Finally any time limitations on the proceedure? Thankyou,


Goody

[BirdeR]

I would imagine that the MRI shows if the cord is compressed or tethered. Dr. Kao asks all(new)or(prospective) patients to have a recent MRI done. Jim also had a CT scan while in Ecuador, another MRI, x-rays, and a spinal tap. (all of these were done before the actual operation) He also had another MRI was done after the operation as was x-rays and a bone density type x-rays done after the operation. This was because Jim asked for one to make sure that his back was actualy strong enough without all the hardware. His past surgeon told him that if he ever had the hardware removed that his back would start to slump...that he NEEDED the hardware and that he should not let anyone tell him otherwise.

[Wise Young]

BirdeR is right. The MRI is the best way to tell whether the spinal cord is compressed. The only problem is that neurosurgeons do not universally agree upon what represents "significant" compression. MRI can easily and consistently detect, for example, compression of the spinal cord by 10% of its diameter. However, most neurosurgeons would not consider this significant compression because a normal person who has 10% of the spinal cord often show little or not neurological deficit. On the other hand, if a person has compression of the spinal cord by about 30%, most neurosurgeons would agree that this is "significant" compression and the spinal cord should be decompressed. Please note that the criterion for compression of the uninjured spinal cord, which has more "reserve" than an injured spinal cord, may differ for the injured spinal cord. Perhaps 10% compression of the spinal cord is really bad for the injured spinal cord and therefore should be sufficient reason to operate.

Tethering, on the other hand, is more difficult to detect. Normally, there should be cerebrospinal fluid all around the spinal cord. If the dura is contacting the spinal cord, this may be due to tethering (i.e. adhesive scar between the spinal cord and dura). There is also tethering between the dura and surrounding tissues. On the other hand, it may not mean tethering. In general, I think that a reasonable criterion for tethering is two consecutive MRI's showing contact between the spinal cord and dura, at the same place over time.

Finally, there is the question of the criterion for operation. Even if the spinal cord is compressed or tethered, many neurosurgeons are reluctant to operate because frequently an operation alone can push the spinal cord to more damage and cause more neurological deficits. This is something that must be decided by a doctor with experience.
Wise.

[Still]

The hyper-baric (sp) chamber also plays an important part in Dr. Kao's operation...the number of days spent in the chamber is also important. It helps the acceptance of the schwann cells and to keep the new nerve implants alive until they begin to grow. Jake found the chamber very uncomfortable the first day, so Dr. Kao gave him medication to keep him calm the second day...by the third day, Jake was able to actually enjoy a movie and a nap while he was in the chamber. Dr. Kao's care of Jake was wonderful. He was so understanding and never made him feel inadequate.

[smith109]

I know there has been around 3 or 5 people from/or know of someone from this web site that has returned from Ecuador about a month ago. Has anyone of you regained any function and what is your progress? My daughter is trying to get more info on him and would like to get a hold of people that has had this done a couple of years ago. Have you heard of anyone that was very unhappy with the results? http://sci.rutgers.edu/forum/images/smilies/confused.gif

[Wise Young]

There is a good discussion going on regarding Dr. Kao's procedures at the following Topic in the Cure Forum (http://carecure.org/forum/showthread.php?t=14384)

[BirdeR]

This is a list for patients of Dr. Carl Kao and for those who care for and participate in their lives. It it the place to share information about past, present and future patients: their needs, their problems,their questions. http://groups.yahoo.com/group/Kao_Patients

[Wise Young]

More discussion on the Cure Forum about the Kao procedures:

DR Kao appears to best hope today (stew5758) (http://carecure.org/forum/showthread.php?t=14384)

dr young, i met dr kao and need a few things clarified (thomas) (http://carecure.org/forum/showthread.php?t=15231)