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Thread: spinal code injury

  1. #1

    Exclamation spinal code injury

    name-Balbir Singh
    age-37 years old
    state-punjab,india
    date of injury-5 sep,2008
    injury level-c6c6 vertical
    date of operate-23rd nov,2008
    he is sound mind.his eyesite is normal.hearing power is also normal and memory is ok.please tell me the duration of treatment time.
    HOw much success rate of c6c7 level injury?
    what is recovery period?
    how much does it cost to cure and mantain the body for its restoration?
    Is it neccessary to cure in china or may be treated in india also?
    please contact me on my contact no:09915401145.or reply me on my email id.
    thanking you.

    waiting for ur reply.hoping for positive results.

  2. #2
    Quote Originally Posted by vikrant View Post
    name-Balbir Singh
    age-37 years old
    state-punjab,india
    date of injury-5 sep,2008
    injury level-c6c6 vertical
    date of operate-23rd nov,2008
    he is sound mind.his eyesite is normal.hearing power is also normal and memory is ok.please tell me the duration of treatment time.
    HOw much success rate of c6c7 level injury?
    what is recovery period?
    how much does it cost to cure and mantain the body for its restoration?
    Is it neccessary to cure in china or may be treated in india also?
    please contact me on my contact no:09915401145.or reply me on my email id.
    thanking you.

    waiting for ur reply.hoping for positive results.
    vikrant,

    I realize that you are probably posting this in response to some story in the media or internet that a group is offering an effective therapy for chronic spinal cord injury. So, let me answer your questions in general terms, describe some of the therapies that are undergoing clinical trial.

    No therapy has been proven to restore function to people with chronic cervical spinal cord injury. Several therapies are being tested in clinical trials or soon will be tested in clinical trials in the United States and Europe but none of the trials have been completed and therefore neither the safety nor efficacy of any therapies have been established. For that reason, you should be very skeptical about any group that makes such claims, particularly any group that wants to people to pay for therapies that they claim to restore function in people with chronic spinal cord injury.

    Several therapies have been shown to be safe and possibly efficacious in preliminary clinical trials. Such trials usually involve too few subjects and are not controlled, i.e. compared with subjects that did not receive the therapy. Phase I (usually to test safety) and phase II (usually to optimize dose and route, to find out which conditions the treatments act on) trials are not sufficient to establish efficacy of a therapy. Several therapies have been or are undergoing through phase I and II trials.

    Cethrin. This is a drug that is placed on the dural surface (outside) of the spinal cord and used to treat 48 subjects of subacute (1-3 days) spinal cord injury. A clinical trial carried out in U.S. and Canada showed that this treatment is safe (no significant complications). Although the trial was not controlled (did not compare treated subjects with untreated subjects), a higher than expected proportion of subjects with cervical spinal cord injury converted from ASIA A (complete) to ASIA C (motor incomplete) spinal cord injury. Note that this trial was only in patients that were within several days after injury. Apparently, patients with thoracic spinal cord injury did not recover as much.

    Fetal Neural Stem Cell Lines. Two companies are now doing clinical trials, using fetal neural stem cell lines. Stem Cell Inc. is a company that has developed fetal neural stem cell lines (from aborted fetuses). A trial in Switzerland had shown that these cells can be safely transplanted into subjects at 6 months after complete (ASIA A) thoracic spinal cord injury. They are proceeding with a phase II study to assess the efficacy of the therapy in patients with incomplete spinal cord injury. Some of the patients recovered sensory function after the transplantation. Neuralstem is a company that transplanted fetal neural stem cells into the spinal cords of patients with severe (late-stage) amyotrophic lateral sclerosis (ALS). believe that the number is now 16). The study showed that the transplants are safe and they are now proceeding to transplant the cells into patients with earlier stage ALS and have applied for permission to transplant these cells into patients with chronic spinal cord injury.

    Bone marrow stromal cells. Many groups are transplanting autologous (from the patient to him- or herself) bone marrow stromal cells. Most of these are doing so by injecting the cells intrathecally (into the cerebral spinal fluid surrounding the spinal cord) but two groups are injecting the cells into the injury site of the spinal cord. For example, Alok Sharma in Bombay has given intrathecal injections of autologous bone marrow cells in over 300 patients with chronic spinal cord injury. A group in Cairo has similarly transplanted over 400 patients with their own bone marrow cells. A group in Germany has been taking bone marrow and providing these cells to patients who would then find doctors to inject these cells intrathecally. Groups in in Jordan and Dubai have been transplanting bone marrow cells into the spinal cord of over 30 patients. So far, no controlled studies have been done. Because there is little or no regulation of autologous cell transplants, many of these groups are charging for these therapies. The procedure appears to be safe and some people have reported some sensory improvement. However, I have examined and met many people who have had no improvements at all. In my opinion, there is no credible evidence that these therapies are restoring function in people with chronic spinal cord injury and this is an unproven experimental therapy.

    Umbilical Cord Blood Mononuclear Cells and Lithium. We are now carrying out clinical trials assessing the safety and efficacy of transplanting increasing doses of HLA-matched umbilical cord blood mononuclear cells into the spinal cord of people with chronic spinal cord injury. We started by injecting four 4-µliters of cell suspension (100,000 cells per µliter) above and below the injury site. After it was clear that this was safe, we progressed to four 8-µliter injections, four 16-µliter injections, and four 16-µliter injections with a bolus of 30 mg/kg IV methylprednisolone (MP), and then 16-µliter injections with MP and a 6-week course of oral lithium. A total of 28 chronic patients have been transplanted and we are doing 6-12 month followups. In December 2012, we should know at least the 6-month outcomes of the treatment. So far, the treatment appears to be safe. At the present, we are not actively recruiting any subjects. In 2013, however, we are planning to initiate clinical trials in China, U.S., and Europe (and possibly in India) to test these therapies further. However, we have not yet decided on all the centers and when the trials will start. Much depends on whether or not we are able to raise the funds and to obtain regulatory permission to initiate the trials.

    I strongly recommend against going for any therapy where you would pay for the therapy. No therapy has been shown to be effective and therefore none has been approved by any regulatory agency for chronic spinal cord injury. All the above therapies (and others) are experimental and some are very likely to be fraudulent. For example, I strongly recommend against so-called "embryonic stem cells" being offered by Geeta Shroff in Delhi. There is no evidence that this treatment is effective and she is charging a lot of money for this treatment. Likewise, at the present, I don't think that there is sufficient data to support the transplanting fetal olfactory ensheathing glial cells into the spinal cord.

    People should not pay for experimental therapies. Legitimate clinical trials do not ask subjects to pay for the costs of the experimental therapy. For example, at ChinaSCINet and all our clinical trials, we do not charge patients to participate in clinical trials. Wherever possible, we try to defray the costs of participating in the clinical trial but we cannot cover things like travel and lodging when people travel for trials. Some of the funding of clinical trials depend on government and other sources that limit who can participate in the trials. That is one of the reasons why we are trying so hard to carry out the clinical trials in multiple sites around the world.

    People frequently ask me why patients cannot pay for experimental therapies. The main reason is because the therapy has not been proven to be effective and has not been approved by regulatory agencies. If people can pay for experimental therapies, there is no point in regulation of therapies because anybody can claim that a therapy works and get people to pay for them. But, what if a doctor or group offers a therapy without making claims of safety and efficacy. Why can't people be allowed to pay for such therapies? If no claims were made of safety and efficacy, why would people be paying money (often a lot of money) for the therapy? Some claims must have been made. Finally, doctors who charge for experimental therapies have a conflict of interest. They will become dependent on the money and have a difficult time saying that the therapy does not work.

    I know that it is very difficult for people to wait and wait for trials. In the meantime, there is plenty that people can and should do to prepare themselves for therapies. It is common sense that people who have spasticity in their legs should try to stand as much as possible each day. This will help build both bone and muscle. Keeping in good health is of course important as well. Some clinical trials may not accept patients who are have active urinary tract infections or decubiti. It is important to exercise to increase cardiovascular and pulmonary function. People should be prepared to do intensive rehabilitation after they have received therapies, including walking. In China, our experience suggests that those who engage in intensive walking exercises after cell transplantation therapy recover more better walking function than those who do not. But, this is of course common sense.

    I will answer the rest of your questions concerning recovery period, etc. later.

    Wise.
    Last edited by Wise Young; 09-06-2012 at 10:36 AM.

  3. #3

    What is the success rate and the recovery time for C6/7 injury?

    Of course, there is no success rate yet because the clinical trials have not yet been done. So, let me address your question theoretically.

    Successful "restoration" of function occur frequently after spinal cord injury. Over 60% of people with spinal cord injury are "incomplete", i.e. they have some function below their injury site (particularly in the lowermost segment S5) after spinal cord injury. Many studies have shown that a large majority of these people (>90%) recover unassisted locomotion and other functions over many months and years.

    This recovery occurs in both cervical and thoracic spinal cord injury. People with incomplete cervical spinal cord injuries have more to recover, i.e. their arms, and often will recover leg function as well. Of course, the less severe the injury, the more recovery will occur. However, many people may have just a patch of sensation or slight movement of one toe and then recover substantial function.

    In animal studies, we and many others have shown that less than 10% of the spinal cord is sufficient to restore unassisted walking in animals and probably in humans. I have been in the operating room with patients who have had tumors removed from their spinal cord and they walk out of the hospital even though they have no more than 10% of their spinal cords.

    So, the goal of regenerating the spinal cord is to add enough axons that reconnect to the correct places to restore function. One does not have to regenerate more than 10% of the spinal cord to restore function. If there are already 8% of the spinal tracts present, perhaps it is sufficient to add 2% to the mix.

    Thoracic spinal cord injury is likely to have poorer results, although this is likely to be an illusion. In the thoracic spinal cord injury, axons have to travel a long ways to (from the injury site to the bottom of the spinal cord at L1) to restore lower limb function. However, in cervical cord injury, regrowing axons may be able to restore arm and hand function with relatively short distance axonal growth.

    Regeneration is very slow, no more than 0.5-1.0 mm per day. In order for axons to grow distances of 500 mm or more, it will take more than 2 or more year. The regenerated axons must also be myelinated in order to function. Therefore, one should not expect such rapid recovery from regenerative therapies. More important, one should not conclude that a therapy does not work at the end of one year.

    Exercise is essential for recovery of motor function. Several decades of research have suggested the unused parts of the central nervous system undergoes atrophy just like muscle. Therefore, after spinal cord injury, it is likely that the parts of the central nervous system responsible for controlling motor responses have atrophied. Intensive repetitive exercise is the only way of restoring motor function.

    In summary, regenerative takes a long time and relearning how to use new connections will take a long time.

    Wise.

  4. #4
    I'm new here,but I havn't met many Dr's who would write that much,thanks
    Nelson
    C-6,complete

  5. #5
    Dr Young,
    thank you for being so clear about the different clinical trials ongoing. I have a question to you. You write that cervical injuries often can improve over a long time. I have an incomplete injury at C5 level. I recovered the ability to walk (short distances and extremely slow, but still) after about 6 months.

    The really sad part is that after 1,5 years, I lost sensation more and more in my right side, both leg and arm/hand. I have now almost lost my ability to walk and I am totally numb in my right hand. What is your experience in this kind of deterioration? Is it common and expected? And, is there anything that can be done about it, axcept for waiting for yours and others research to come to a solution?

    Christin

  6. #6

    D6Spinal cord injury

    this article is counter the article you posted 2005 when you talked about regenerative opearations as a hope particulary for upper and middle thoracic spinal cord injury as you said earlier they would be the first candidates for such operations what is new to change that hope as you said in this article that cervical sci would respond more than thoracic sci which would respond poorer?
    Last edited by paralagia; 09-06-2012 at 04:45 PM.

  7. #7
    The reason for my post reply is the condition of my husband that i hoped to be cured using stem cells .
    please DR.Wise Young take a look at the case and reply with your notes and recomendations:
    My husband is a recent complete paralagic due to complete spinal cord transection at D6 level without spinal cord tissue loss 2 months ago and he performed succesfull surgical spinal cord fixation OF D4 D5 D6 and D7 levels
    with the following findings by MRI for the dorsal spine (15-7-2012) after car accident by 19 days.
    1- there is a normal allign of screws with no evedence of displacement or mal- positioning.
    2-ther is retrolisthesis of D5 over D6 vertebrral bodies.
    3-the cord shows increased signal intensities from the level of D4 down to the level of D12 that could indicate (oedema/contusion).
    4-D9-D10 show left paracentral protrusion with cranial migration indenting the vertebral aspect of the cord encroaching upon left D10 nerve root at the level of the recess.
    5- slight D3-D4 disk bulge indenting the anterior subarachoid space with no evedence of sighnificant foraminal compromise.
    6-No other MRI abnormalities detcted.
    ***Please acess the case giving me(Via e-mail) your notes on the case according to the most recent of SCI and please send me name and location (if possible) of a chinese hospital (s)that perform stem cell transplantation succesfully and truthfuly according to the most recent technique. please Help .
    Last edited by paralagia; 09-06-2012 at 04:46 PM.

  8. #8
    Senior Member lunasicc42's Avatar
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    Quote Originally Posted by Christin L View Post
    Dr Young,
    thank you for being so clear about the different clinical trials ongoing. I have a question to you. You write that cervical injuries often can improve over a long time. I have an incomplete injury at C5 level. I recovered the ability to walk (short distances and extremely slow, but still) after about 6 months.

    The really sad part is that after 1,5 years, I lost sensation more and more in my right side, both leg and arm/hand. I have now almost lost my ability to walk and I am totally numb in my right hand. What is your experience in this kind of deterioration? Is it common and expected? And, is there anything that can be done about it, axcept for waiting for yours and others research to come to a solution?

    Christin
    Do you think that you could be developing a syrinx? Do you get headaches when you lay flat?

    The reason I ask is because I developed a syrinx a little while after my injury. I would get mind-numbing headaches when I went too quickly from a sitting position to a flat position, then I slowly lost all the function in my left arm before I went in for an mri and they saw the syrinx. They said that when they shunt the syrinx that the lost function may or may not come back.

    I hate to come off like I am trying to scare you but I had similar symptoms and thats what mine was

    You might wanna get an mri
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  9. #9
    Lunasicc42,
    I do think it has to do with a syrinx. The doctor suspected it and I had an MRI in March 2011 and in October 2011. The size of the syrinx was the same and the surgeon said I wasn´t bad enough for a surgery. He also said I wouldn´t get any better after the surgery. And now I´m so bad at walking that I feel it is too late for surgery. It feels so frustrating not to get any help, as if they don´t take me seriously.

    Did you have a surgery to remove/reduce the syrinx, and what was the outcome in that case?

    Kind regards,
    Christin

  10. #10
    Quote Originally Posted by Wise Young View Post
    It is common sense that people who have spasticity in their legs should try to stand as much as possible each day.

    Dr. Young,

    My level of injury is at L1 and although I've gone from ASIA A to ASIA C (within 1 year and 2 months since the injury), doctors tell me that the cord was severed from a piece of the spine that exploded during the impact.

    My therapists tell me that I should stand/walk often on my KAFO's but, I don't see how it can help since I'm a lower motor neuron and have no spasms in my legs. My bladder; however, does spasm (which i never quite understood- why my legs don't spasm but, my bladder does).

    I was hoping you could give me a bit of insight on what I can do to prevent muscle atrophy without muscle spasms. My right leg has some quad and hamstrings so it's significantly larger than my left one and it's starting to make me self conscious. I had just transferred to UCI before my accident and I just want to make myself as "normal" as possible before meeting new folks.

    Thanks a bunch!

    Sincerely,
    David

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