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Thread: Hypothetical Treatment - Nerve Rerouting + Detethering

  1. #1

    Hypothetical Treatment - Nerve Rerouting + Detethering

    I experienced L1 burst fracture, thoracolumbar SCI, ASIA A, complete paraplegia, neurogenic pain, bladder and bowel complication. I pay interest to nerve rerouting. I try to create a hypothetical treatment.

    First, detether my nerve root. This will then treat my neurogenic pain.

    Second, connect lumbar-level L5 ventral nerve root to the sacral-level S3 (or S2) ventral nerve root. This will restore my sexual function and bladder bowel control (i think no sensation recovery)(Dr Xiao CG). I am not sure how and whether this will restore bowel function. If i scratch dermatome to trigger pissing, do i defecate (leak) at the same time?

    Third, reroute intercostal nerves to pudendal nerves. Besides to restore my bladder and bowel control, it may restore my B/B sensation as well (Dr Zhang ShaoCheng). This may also trigger voluntary control of B/B. This may perfect or enhance the ventral nerve rerouting done before
    .

    Fourth,
    the peroneal nerve (a nerve to the leg) is used as a bridge directly from the spinal cord above the injury site to the nerves of the gluteus and quadriceps muscles (DrGiorgio Brunell).

    or

    reroute ulnar
    nerves to paralysis-affected femoral and ilioinguinal nerves, restoring some ambulation and pelvic-area sensation, and to obturator nerves to restore some leg-muscle function (Dr Zhang ShaoCheng).

    or

    transfer intercostal neves to the vertebral canal through a submuscle tunnel and sutured with the selected fascicula of lumbar nerve roots (L 1/2 or L 3/4) by epiperineurial neurorrhaphy in the subdura or extradura (Dr Zhang ShaoCheng). However, this part of treatment may be avoided to reduce amount of intercostal nerve loss (there have been some intercostal nerve loss before for restoring bladder and bowel functions)


    I said 'hypothetical' because i don't know whether the above is feasible. There are few issues.

    First, the cost. It involves treatment of two or more drs. I contacted Dr Zhang and Dr Xiao before; they quoted to me their charges. But i never contacted
    Dr Giorgio Brunelli; i don't his charge. I may not be able to afford all the total cost.

    Sec, no of operations. I have to do many operations. Very scary!!

    Third, the side effects. I don't know exactly how much/the extent of the impact of the treatment on the functions of the other parts of body. I have pneumonia. If i have difficulty coughing up phlegm following the treatment, that is troublesome.

    I have no problems with my arms and breathing, so i don't have to do treatment for this.

    It seems that, after i do the treatment, i may ideally stand, walk, urinate, defecate. My pain on my limbs will be ideally solved. My sexual functions will be ideally restored.

    Is my proposal of hypothetical treatment feasible? Your comments?


  2. #2
    I would recommend contacting Neurosurgeon Dr. Justin Brown at UCSD.

  3. #3
    Senior Member lynnifer's Avatar
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    Opinions differ but Xaio was a scam. Doesn't work. Try Ampyra? B/B/S is something many people are after ... no treatments since paralytic started surviving (WWII). Sorry.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  4. #4
    Bitpo,

    I know that you have been seeking answers to your question for some time and I have not had time to write a comprehensive answer to your questions. So. Let me try to present some critical evaluations of your proposed therapeutic approaches.

    1. Untethering the spinal roots may be useful. However, everything presupposes that the spinal roots are tethered, i.e. have significant scarring. This may or may not be true. Neither MRI or CT scans can show whether such scarring exists and how bad it is. Everything depends on what the neurosurgeon discovers when he or she exposed the roots and gets a good look at them.

    2. More evidence is required before one can or should assume that rerouting lumbar spinal root to the S2 spinal root will improve bladder function for people who have damage to their sacral spinal cord. A spastic bladder may be a pre-requisite for such L2-S2 re-routing to work. Nobody expects the re-routed axons to be able to do everything to get a bladder to contract while relaxing the two sphincters (one in the case of women) that allows the urine to come out. It is likely that the extra axons that come from the L2 root may be providing some extra excitability that the system requires to initiate a full micturition response.

    3. There is also some controversy concerning the best source of lumbar or even thoracic ventral root to re-route to the sacral roots (S2) innervating the pudendal nerve. Note that the procedure should be much improved if the surgeons actually did electrophysiology to assess which roots actually innervates the pudendal nerve. In the 1980's, when I helped monitor surgery to do partial rhizotomy procedures to reduce spasticity of the lower limbs in children with cerebral palsy, we found that innervation of the pudendal nerve can vary from S1, S2, and S3 from one or both sides. So, the results of the procedures probably will be better with better intraoperative electrophysiological testing. Finally, the evidence that such bridging helps restore sexual function or even anal sphincter function is controversial and not yet convincing. The best evidence to date suggests that perhaps a third of people with spinal cord injury may recover micturition after such re-routing but little or no evidence support the statement that such re-routing helps anal sphincter contraction or sexual function, such as anal function.

    4. Other nerves might be suitable or even better than L2 re-routing to S2 but only one paper suggest that intercostal donor nerves are effective improving bladder function and I have not yet heard of any success resulting from ulnar bridging to the bladder. I have asked Dr. Xiao on several occasions whether the L2 to S2 procedure helps sexual function or anal sphincter function and he was reluctant to say. So, it is safe to say that the evidence is not yet available on and I don't think that we should assume that the re-routing procedure will help with defecation or erection until definitive evidence is available.

    On at least one occasion, i.e. Jawaid, the re-routing of L2 to S2 in somebody with a conus injury did not restore bladder or sexual function. You should wait until there is more experience and critical analysis of the data before undergoing any of these procedures.

    Wise.






    Quote Originally Posted by Bitpo View Post
    I experienced L1 burst fracture, thoracolumbar SCI, ASIA A, complete paraplegia, neurogenic pain, bladder and bowel complication. I pay interest to nerve rerouting. I try to create a hypothetical treatment.

    First, detether my nerve root. This will then treat my neurogenic pain.

    Second, connect lumbar-level L5 ventral nerve root to the sacral-level S3 (or S2) ventral nerve root. This will restore my sexual function and bladder bowel control (i think no sensation recovery)(Dr Xiao CG). I am not sure how and whether this will restore bowel function. If i scratch dermatome to trigger pissing, do i defecate (leak) at the same time?

    Third, rerouting intercostal nerves to pudendal nerves is not the same as lumbar-to-. Besides to restore my bladder and bowel control, it may restore my B/B sensation as well (Dr Zhang ShaoCheng). This may also trigger voluntary control of B/B. This may perfect or enhance the ventral nerve rerouting done before
    .

    Fourth,
    the peroneal nerve (a nerve to the leg) is used as a bridge directly from the spinal cord above the injury site to the nerves of the gluteus and quadriceps muscles (DrGiorgio Brunell).

    or

    reroute ulnar
    nerves to paralysis-affected femoral and ilioinguinal nerves, restoring some ambulation and pelvic-area sensation, and to obturator nerves to restore some leg-muscle function (Dr Zhang ShaoCheng).

    or

    transfer intercostal neves to the vertebral canal through a submuscle tunnel and sutured with the selected fascicula of lumbar nerve roots (L 1/2 or L 3/4) by epiperineurial neurorrhaphy in the subdura or extradura (Dr Zhang ShaoCheng). However, this part of treatment may be avoided to reduce amount of intercostal nerve loss (there have been some intercostal nerve loss before for restoring bladder and bowel functions)


    I said 'hypothetical' because i don't know whether the above is feasible. There are few issues.

    First, the cost. It involves treatment of two or more drs. I contacted Dr Zhang and Dr Xiao before; they quoted to me their charges. But i never contacted
    Dr Giorgio Brunelli; i don't his charge. I may not be able to afford all the total cost.

    Sec, no of operations. I have to do many operations. Very scary!!

    Third, the side effects. I don't know exactly how much/the extent of the impact of the treatment on the functions of the other parts of body. I have pneumonia. If i have difficulty coughing up phlegm following the treatment, that is troublesome.

    I have no problems with my arms and breathing, so i don't have to do treatment for this.

    It seems that, after i do the treatment, i may ideally stand, walk, urinate, defecate. My pain on my limbs will be ideally solved. My sexual functions will be ideally restored.

    Is my proposal of hypothetical treatment feasible? Your comments?


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