Quote Originally Posted by Geoman View Post
Wise, appoligies for crossing over forums, but I just had a query regarding the reduced pain following untethering surgery in your response above. Firstly, I assume you're referring to neuropathic (central) pain. I'm a T10 complete from a trauma 6 year ago and suffer pretty bad NP. I've tried all of the typical medications and the only relief I'm getting at the moment is Fentynal patches. I while ago I had an MRI for a trial stimulator implant (which was unsuccessful), and the MRI showed a small cavity which at first was thought to be a syrinx, but my original surgeon reviewed it and convinced me it that the cavity was present immediately following my injury. My question is, if the MRI doesn't necessarily detect tethering, is there anything we can do to determine if the untethering procedure is likely to help with NP apart from the trial and error of surgery itself.

Thanks,
Clayton
Clayton,

Dr. Yansheng Liu probably has more experience operating on chronic spinal cord injury than anybody I know. He says that every case is different and he tells his patients that he cannot predict which cases will improve. The goal of his surgery is to relieve all constrictions, remove adhesions between the spinal cord and surrounding tissues, and restore cerebrospinal fluid flow. Thankfully, none of his patients have gotten worse from the surgery.

Dr. Liu and Dr. Zhu have agreed to organize all the untethering cases that their team has done over the years and I have agreed to help them write it up. We will try to do this as soon as possible. We also discussed the control group in the phase III study and agreed that it should consist of untethering surgery without injection of cells into the spinal cord. This is only possible if we have evidence that the surgery alone has some benefit.

When the MRI shows a constriction or compression of the spinal cord, that usually means tethering. Normally, there should be cerebrospinal fluid all around the spinal cord. If the spinal cord is not constricted or compressed but still consistently touching one side, this suggests tethering. Ever since they found that opening up the dura of subacute spinal cord injury cases improves recovery in patients classified as ASIA A, they have been exposing many spinal cords.

But, in answer to your question, while MRI's can show evidence of tethering, it sometimes does not show anything suspicious and then surgery reveals tethering or vice versa. There are no guarantees that the untethering will reduce neuropathic pain or will restore function. I don't know what the percentages of recovery are in his series. I guess that when we compile the data, we will find out.

Wise.,