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Thread: Carl Kao's Surgical Procedures in Ecuador

  1. #11

    Details on Jim's surgery and medications and exercises

    DETAILS ON JIM'S SURGERY-FRIDAY, AUGUST 24 (12HOURS) 1) removal of existing bone stimulater, rods, hooks, and screws from back. 2) laminectomy T6-T12 inclusive total 7 levels. 3) transpedicle anterior vertebretomy to remove bone compression in front of spinal cord until flat at T10 level. 4) bilateral forminotomy at T10 to decompress the nerve roots. 5) bilateral lateral gutter bone fusion. 6) microsurgical intradural release of arachnoid adhesions and evacuation of spinal cord cavity 4.5 cm. long at T7-T10 levels. 7) implantation of 15 fascicles of sural nerve together with dissociated Schwann cells into spinal cord cavity. 8) closure of pia over the implants with 7-0 Prolene thus retain the implants within the spinal cord. 9) suture fixation of a piece of omentum to the spinal cord and both sides of dura. 10) dural graft autologous fascia lata. 11) Jim completed (as do all the patients) 13 hyperbaric oxygen therapy sessions following the surgery each lasted 2.5 hours each. (1 session per day). ************************************************** *********** MEDICATIONS THAT JIM IS ON OR WILL BE ON: 1) Proviron, (testosterone) 2 tabs. before breakfast each day for 6 months. 2) Yohimbine 5.4 mg., 2 tabs. before sleep at night each day for 1 year. 3) Viagra 100mg., 1 tab. as needed 4) Urecholine 25 mg., 1 tab 3x a day before meals for aprox. 6-8 months. 5) Dibenzylene 10 mg., 1 tab. 3x a day before meals for aprox. 6-8 months. 6) 4-AP from Mr. Greg Dent who will decide along with Dr. Kao on the exact dosage. ************************************************** ***********JIMS BEGINING EXERCISE PROGRAM 1) begining 9/8: continue range of motion exercises at least 2x a day every day on both legs (as shown to us). 2) begining 9/14: begin to stand in standing frame/table (as was shown to us) 1hr. in AM and 1 hr. in PM. (at least). 3) begining 9/21: begin iliopsoas exercises , (with equipment shown to us), against 35-40 lbs. weight (as shown to us). Start at 1hr. a day (1/2 hr. per leg). May work up from that. 4) begining 9/28: begin leg exercises in face up position, (with equipment shown to us), against 30lbs. weight (to start) (as shown to us). 2 hours a day (1 hr. per leg). May work up from that.

  2. #12
    hi there dr.young,what is this surgery doing that poeple are able to stand up in a matter of a couple of weeks with just leg braces that look like they only go up to your calfs?and it seems like in the last 3 months or so that every thing has slowed down,that nothing is coming up about trails or new discoverys,i use to here breaking news every week or promising stuff?just curious,thanks jeff

  3. #13
    jeff, it is hard to say for sure but I believe that the recovery of function that we are seeing from Dr. Kao's surgery is restoration of function of existing connections. It is occurring too fast for regeneration and possibly remyelination. However, we should not rule out the latter possibility since Dr. Kao is transplanting Schwann cells through the peripheral nerve graft to the injury site. Certainly decompression and untethering have both been reported to restore function to the same extent by other surgeons (for example, this has long been reported by Hank Bohlman). U.S. surgeons have been traditionally reluctant to operate on chronic spinal cord injury because there is a tendency for readhesion and scarring. Also, many surgeons have been burned by loss of function after they have operated. I must say that I am impressed by the recent spate of recoveries that have been reported by people from our forums that have gone to Ecuador.

    In India, where I spent 7 days touring eight spinal cord injury centers, a number of Indian neurosurgeons have shared experiences (and I saw the patients) that are similar. For example, in Coimbature (in Southern India), one of the most experienced neurosurgeons in India operated on a patient just one day before I arrived. This patient was apparently a "complete" injury with flaccid lower limbs and no reflexes, voluntary movement, or sensation below T11. A team of neurosurgeons, including one from Japan, examined the patient. If I remember correctly, the patient was more than two weeks after injury and had some compression of the cord. In any case, by the time I arrived, they had re-examined the patient at 24 hours after decompression. The patient reports some movement of one leg and sensation in both legs. This was reported by the team of neurosurgeons who had really no expectation of any recovery and was doing the surgery as a demonstration of how to decompress the cord at that level.

    Regarding the dearth of news concerning spinal cord injury advances, there are many reasons. The first and foremost is the lack of any news reports of anything else but the attacks on the World Trade Center and Pentagon, as well as the economic aftermath. The second is that we are just about 6 weeks from the Society for Neuroscience meeting where there will be a flood of new work. This may be the calm before the storm. The third is that most scientists (like myself) are just stunned by the events of the past several weeks and have been trying to deal with the unfolding tragedies.

    I will post more in the Life Forum concerning the effects of the tragic events on scientific activities around the world.

    Wise.

  4. #14
    thanks dr.young for your reply,jeff

  5. #15
    Junior Member
    Join Date
    Aug 2001
    Location
    Houston, Texas USA
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    24

    tethering or compression

    Dr Young,
    what tests would show whether there is tethering or compression in the spinal cord?
    MRI or CT scan I suppose? Or would it have to be a neurospect scan?
    Thanks and very glad you are safely home

    Russ Byrd

  6. #16

    Dr. Young...

    How does a person find out if there may be compression in the cord? Would a MRI help? Finally any time limitations on the proceedure? Thankyou,


    Goody

  7. #17
    I would imagine that the MRI shows if the cord is compressed or tethered. Dr. Kao asks all(new)or(prospective) patients to have a recent MRI done. Jim also had a CT scan while in Ecuador, another MRI, x-rays, and a spinal tap. (all of these were done before the actual operation) He also had another MRI was done after the operation as was x-rays and a bone density type x-rays done after the operation. This was because Jim asked for one to make sure that his back was actualy strong enough without all the hardware. His past surgeon told him that if he ever had the hardware removed that his back would start to slump...that he NEEDED the hardware and that he should not let anyone tell him otherwise.

  8. #18
    BirdeR is right. The MRI is the best way to tell whether the spinal cord is compressed. The only problem is that neurosurgeons do not universally agree upon what represents "significant" compression. MRI can easily and consistently detect, for example, compression of the spinal cord by 10% of its diameter. However, most neurosurgeons would not consider this significant compression because a normal person who has 10% of the spinal cord often show little or not neurological deficit. On the other hand, if a person has compression of the spinal cord by about 30%, most neurosurgeons would agree that this is "significant" compression and the spinal cord should be decompressed. Please note that the criterion for compression of the uninjured spinal cord, which has more "reserve" than an injured spinal cord, may differ for the injured spinal cord. Perhaps 10% compression of the spinal cord is really bad for the injured spinal cord and therefore should be sufficient reason to operate.

    Tethering, on the other hand, is more difficult to detect. Normally, there should be cerebrospinal fluid all around the spinal cord. If the dura is contacting the spinal cord, this may be due to tethering (i.e. adhesive scar between the spinal cord and dura). There is also tethering between the dura and surrounding tissues. On the other hand, it may not mean tethering. In general, I think that a reasonable criterion for tethering is two consecutive MRI's showing contact between the spinal cord and dura, at the same place over time.

    Finally, there is the question of the criterion for operation. Even if the spinal cord is compressed or tethered, many neurosurgeons are reluctant to operate because frequently an operation alone can push the spinal cord to more damage and cause more neurological deficits. This is something that must be decided by a doctor with experience.
    Wise.

  9. #19

    Dr. Kao's operation

    The hyper-baric (sp) chamber also plays an important part in Dr. Kao's operation...the number of days spent in the chamber is also important. It helps the acceptance of the schwann cells and to keep the new nerve implants alive until they begin to grow. Jake found the chamber very uncomfortable the first day, so Dr. Kao gave him medication to keep him calm the second day...by the third day, Jake was able to actually enjoy a movie and a nap while he was in the chamber. Dr. Kao's care of Jake was wonderful. He was so understanding and never made him feel inadequate.

  10. #20
    Junior Member
    Join Date
    Jul 2001
    Location
    Bethel, OH, USA
    Posts
    11

    Dr Kao

    I know there has been around 3 or 5 people from/or know of someone from this web site that has returned from Ecuador about a month ago. Has anyone of you regained any function and what is your progress? My daughter is trying to get more info on him and would like to get a hold of people that has had this done a couple of years ago. Have you heard of anyone that was very unhappy with the results?

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