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Thread: Dr. W. Young - Cord Tethering, again and again....

  1. #1
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    Dr. W. Young - Cord Tethering, again and again....

    Dr. Young, I have undergone 2 surgeries now to de-tether my spinal cord. In both surgeries the outcome looked promising, but now (again) after only 3 months post surgery, my spinal cord has re-tethered and is causing a fluid blockage/syrinx.

    My neurosurgeon seems to be frustrated and at a loss as to what options are viable. Do you have any information on new techniques or new grafting materials that might be appropriate? I can't tell you how nervous it makes me knowing that my neurosurgeon doesn't know what to do.

  2. #2
    Carthief,

    We have been working on this problem, developing biodegradable materials that can be used to prevent adhesion of the spinal cord to the dura/arachnoid responsible for tethering the cord. I have been quite concerned about this problem because knowledge that the spinal cord will form adhesive scars and retether is one of the main reasons why neurosurgeons are reluctant to expose the injured spinal cord surgically. They will usually not do so unless there is clear and compelling evidence of progressive neurological deficits. This is also a problem that we encounter in our animals when we try to do chronic spinal cord transplantations. I believe that this problem is solvable with the use of biomaterials and also with methylprednisolone treatment (which reduces the extent of scarring).

    The development of appropriate biomaterials for spinal cord repair is not a trivial problem. Although we have tried many dozens of materials, most increase inflammation rather than decrease inflammation. However, we have found some that reduce and prevent adhesions at least in rats. Therefore, I am hopeful that this problem will be resolved in the next few years. In the meantime, if you ever do have untethering surgery again before these materials become available, one suggestion that I have is for your neurosurgeon to use methylprednisolone before the surgery to reduce the inflammatory response of the spinal cord and surrounding tissues to surgery.

    Wise.

  3. #3
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    Thank you Dr. Young, I will definitely suggest methylprednisolone.

    In the first surgery, Bovine pericardium was used, which was removed and replaced by my own fascia tissue (taken from my leg) in the second surgery.
    Can you suggest any specific biomaterials that might be an option?

  4. #4
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    Dr. Young:

    What are these biomaterials that prevent cord/dura adhesion in rats? Are they experimental proprietary substances that you would be willing to allow others to use when testing chronic SCI regenerative treatments? Or are they already universally available to researchers on the research market? What are they called?

    James Kelly

  5. #5
    Jim, we are still working on it right now. There are many materials and we are screening a bunch of them. Wise.

  6. #6
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    Dr. Young,

    I'm glad to hear this news. However, I need to ask you again: are these your proprietary materials, or are they available for others to use (for research in rats). If the former, will you share or sell a sample? If the latter, will you tell us the material's names? I realize you're still in the process of screening them for effectiveness. But others are conducting in-vivo testing of combination regenerative treatments for chronic SCI. Part of these studies involve surgical techniques, which for the sake of achieving maximum functional results must not lead to cord/dura tethering. They may be willing to test two or more of the materials in question as part of their experimental protocols. Since you've personally said again and again that you wish to promote a cooperative spirit among scientists working to cure SCI, I felt that you would be happy to share this information.

    If you're unwilling to discuss this matter publicly, could you email your phone number to me at OldDrooler@hcnews.com. I will forward it to the researchers in question to allow them to call you directly.

    James Kelly

  7. #7
    Jim, these are not "my" proprietary materials nor do I have any financial stakes. We are working with several different groups (including companies) evaluating many different materials. The study is still ongoing. I have indicated that I have believe that this is an important problem and while we have some preliminary data, the data must be confirmed. The problem is not easy nor is it a simple one. I am not trying to hold you off but simply saying that we are working on the problem and we don't have the answer yet.

    Wise.

  8. #8
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    fluid blockage

    CarThief,

    There is a very good chance that the Omental Transposition procedure can solve your problem.
    It sounds like you are trying extremely hard to improve your situation. So perhaps you will look at the benefits of the OT procedure.

    There is much documentation showing the amazing absorptive ability that the omentum has. In fact it is one of the best reasons why this procedure should be available to all SCI patients. Preferably at the initial surgery when the worst of the swelling causing most of the damage to the cord. This can be prevented by laying a pedicled portion of the omentum on the site of the injury allowing the omentum to absorb the damaging fluid as well as maintaining an uninterrupted supply of nutrient rich blood flow where you need it most. It is the obsorbtive function of the omentum along with numerous other properties that causes the omentum to have the ability to obliterate cysts as well as facilitate nerve regeneration. This is only the begining of the what research has shown are the positive things the omentum can do.

    If C. Reeve would have this surgery he would not need the vent.

    Brian Sternberg, 30 years post injury, had the same pressure on the diaphram that Reeve is experiencing. Sternberg could only whisper for 30 years and could only sit up for short periods of time. Now he talks with a full voice and can stay up for long periods of time allowing him to do things like travel, that, until the omental transpostion procedure was done, he could not do.
    I can give you Brian Sternbergs E-mail so you can ask him about the improvements in his condition after he had the procedure 30 YEARS POST INJURY.

    Dr. Goldsmith, the pioneer of this procedure lives in Navada, near Vegas. He is a very knowledgeable, kind man who is very accessible and answers his home phone. Check out this web site and give Goldsmith a call. I think he can help you. http://members.cox.net/afonseca1/

    Sincerely, Meeker

    jrm design art studio

    [This message was edited by meeker on Sep 20, 2002 at 10:37 PM.]

    [This message was edited by meeker on Sep 21, 2002 at 05:59 PM.]

  9. #9
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    untethering and cyst

    Treatment of Refractory Progressive Post-traumatic Cystic Myelopathy with a New Technique: Myelocyst-Omental Graft

    Scott P. Falci, M.D., Paul Zweibel, M.D.
    Craig Hospital; Craig Center for Spinal Cord Research, Englewood, CO.

    Progressive post-traumatic cystic myelopathy is treated with various shunting techniques and spinal cord untethering. In some cases the injury is so severe that un tethering cannot be performed and the cyst remains refractory to shunting procedures. We describe the first case of spinal cord cyst obliteration in a patient using his own omentum on it's vascular pedicle.

    The patient is a 38 year old C5 quadriplegic male with ascending cystic myelopathy into the brain stem. Multiple shunting procedures failed to stop the progression of the cyst. After his third shunting in one years time, the patient presented with respiratory compromise and weakness of accessory muscles of respiration. Baseline FUC was 440 cc sitting, 800 cc supine. A myelocyst-omental graft was performed, filling the cyst cavity with the patients omentum maintained on it's vascular pedicle. At one year follow up, the patients cyst has been obliterated with omental graft, his FUC is 180% of baseline, his accessory muscles of respiration have increased in strength, he has recruited new muscle groups, and he is living independently at home. He, in fact, progressed to a neurological state which existed two years prior to the surgery.

    It is felt that omentum incorporates into the cord tissue, providing additional vascularity and cellular matrix, thereby halting cystic myelopathy.

    jrm design art studio

  10. #10
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    Dr. Young:

    I understand perfectly what you're doing. You made than clear from the outset. I simply want the names of the substances you're using to prevent adhesions from forming. I understand completely that your research involving these substances is still at a basic level. Others are interested in this problem, are looking for answers, and may be interested to know what Wise Young thinks has potential in this regards. Are you under contract regarding all the methods you're testing not to divulge information concerning their identity? Don't you want to cooperate and collaborate with your peers to possibly hasten the advent of a cure? I thought that one of your most basic goals was to foster an open, sharing spirit in the SCI Research Community?

    James Kelly

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