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Thread: After years of incremental progress, spinal cord repair is edging toward reality

  1. #1

    After years of incremental progress, spinal cord repair is edging toward reality


    Has no date this article, but I think is new.

    unbroken dreams
    After years of incremental progress, spinal cord repair is edging toward reality

    Illustration: Dan Page
    By Marcia Kaye

    Bruce Brady doesn’t remember slamming headfirst into the cedar rail fence. All he knows is that one minute he was skiing along the bottom of the hill toward the chalet to meet up with his son, and the next minute he was lying on the ground, bleeding from a large gash in his forehead and utterly immobile. “I couldn’t feel my feet or hands,” recalls the 48-year-old Toronto father of three. “I could only move my eyes and talk.”

    Brady might have spent the rest of his life as a motor quadriplegic – paralyzed from the neck down, with minimal sensation in his legs – if not for the surgery that he underwent at Toronto Western Hospital three days after his injury. The operation relieved pressure on his spinal cord and fused five upper vertebrae together with a steel bar. Within two weeks Brady was able to stand and take a few steps; after three weeks he was walking quite well. Today, a year later, he says with some amazement, “I’m fully mobile.” Although Brady still suffers from a stiff neck and pain in his upper arms, in February he returned to his physically demanding job as an industrial sheet metal worker.

    Paralyzed patients walking away from their injuries? It sounds like the stuff of science fiction. But U of T researchers say new surgical techniques, drugs, gene therapies and rehabilitation devices are helping to make significant improvements in the lives of people with spinal cord injuries. “There is real hope, and there has been real progress,” says neurosurgeon Michael Fehlings, a U of T professor in the department of surgery and the one who operated on Brady. Fehlings is also the director of the spinal program at Toronto Western’s Krembil Neuroscience Centre, the largest neuroscience centre in Canada and a world leader in spinal cord research. As he leads the way through his lab, where graduate and undergraduate students are busily examining tissue sections of a spinal cord under a microscope, characterizing types of neural stem cells, and performing delicate spinal surgery on a rodent behind closed curtains, he says, “There’s work going on all over the world, but much of the seminal work has occurred in Canada, and U of T is right in the thick of things.”

    Bruce Brady’s case is an example of only one exciting strategy being used to repair the spinal cord. Brady is one of 250 people enrolled in a clinical study called STASCIS, which stands for Surgical Treatment for Acute Spinal Cord Injury Study. Fehlings, who is spearheading the multicentre study, says that in the past, patients like Brady wouldn’t have received surgery at all – let alone surgery so soon after their injury – because their necks weren’t broken but “merely” compressed. In one-third of spinal cord injuries, especially in aging but active baby boomers such as Brady, the spinal cord undergoes a combination of contusion and compression. The cord (actually a long thin bundle of nerves enclosed by the vertebrae) is jolted against bone spurs, which develop as we age, and then jammed into the tight spinal canal.

    While compression sounds less serious than a fracture, the results can be just as devastating because after the trauma the nerve cells inside the spinal cord start to die, causing loss of movement, sensation, bladder and bowel control, and sexual function. “Without decompression surgery, it’s doubtful that Bruce would have improved from a complete motor quadriplegic after injury to virtually normal,” says Fehlings. The STASCIS data are just starting to emerge, but Fehlings hopes they will help determine the optimal time for surgery; so far it’s looking as though the earlier, the better. The next step: establishing guidelines about how and when to use the surgery, and spreading knowledge of the technique to certain designated hospitals across Canada. As Fehlings puts it, we’re entering a golden era of spinal cord research, reflected at U of T in a special collaboration among the fields of biology, chemistry and engineering. And Canadian research is attracting worldwide attention.


  2. #2
    This Fehlings is one of the proponents of not having steroids be a standard of care.

  3. #3
    Quote Originally Posted by manouli

    Has no date this article, but I think is new.
    The link to other articles in "this issue" takes you to the Spring 2008 issue.

  4. #4
    I thought that spinal decompression surgery was a fairly common thing these days... Although there has been a debate as to whether it should be done immediately or several days after the injury.

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