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Thread: Is there any research or trials going on for Caudaequina or Conus injuries?

  1. #1
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    Is there any research or trials going on for Caudaequina or Conus injuries?

    I am anxious to know that if there is any research or clinical trials going for caudaequina or conus injuries? Is there any hope for such patients to regain bladder bowel and sexual function in near future? Is any doctor or research team doing some thing especially for bladder bowel and sexual function? Why there is no clinical trial starting for such injuries?

    Jawaid

  2. #2
    Quote Originally Posted by Jawaid View Post
    I am anxious to know that if there is any research or clinical trials going for caudaequina or conus injuries? Is there any hope for such patients to regain bladder bowel and sexual function in near future? Is any doctor or research team doing some thing especially for bladder bowel and sexual function? Why there is no clinical trial starting for such injuries?

    Jawaid
    The spinal cord ends just below the L1 vertebral segment in most mammalian species, including human. From L1 down, spinal roots descend to exit from the appropriate intersegmental foramenal openings. Thus, the spinal canal between L1 and S5 are filled with spinal roots. Injury to the spine between L2 and S5 usually results in damage to the spinal roots and not the spinal cord. Injury to L1 often will damage the conus or the tip of the spinal cord. The neurological loss depends on the roots that are injured.

    The sacral segments of the spinal cord are located in the conus and this results in a saddle-shape loss of sacral sensation (usually involving the same skin area that would contact a saddle), as well as loss of bladder, bowel, and sexual function. The bladder and anal sphincter may be flaccid. Constipation may be present. There may be paralysis and atrophy of muscles innervated by the sacral segments, including those of the foot. Note that while a conus injury is a spinal cord injury, it is often associated with cauda equina injury.

    At the present, treatment for cauda equina injury is mostly based on surgery to decompress the roots and to remove adhesions and scarring of the roots that may prevent regeneration. Because cauda equina injury damages sensory roots that are entering the spinal cord, the axons usually cannot enter the cord. This is unlike the damage to the peripheral side of the sensory nerve that can regenerate. If the damage to the roots is not too severe, motor axons in the spinal roots may regenerate.

    Treatments of conus injury, however, is primarily surgical. The first goal is to remove compression of the conus, whether due to bone, disc, or tumor. In the case of prolonged compression, adhesions and scarring may have developed and surgery may be worthwhile.

    In terms of experimental therapies, however, the number of treatment options are still quite limited. The most exciting work, in my opinion, comes from three areas:
    • Neural Stem Cells. Douglas Kerr at Johns Hopkins has injected neural stem cells derived from mouse or human embryonic stem cells into the spinal cord, treated the spinal cord with drugs that stimulate regeneration, and found that the transplanted cells sent axons out of the spinal roots and reinnervated muscle.
    • Olfactory ensheathing glia (OEG). Several groups have been interested in using OEG cells to facilitate regeneration of sensory fibers into the spinal cord. Geoffrey Raisman, for example, is working with surgeons at the Royal Orthopedic Hospital in London to inject OEG cells into the dorsal root entry zone where brachial plexus nerves have been avulsed from the spinal cord and then re-implant the nerves.
    • Peripheral nerve bridging. Surgeons in China have been bridging nerves from above and below the injury to site to bring function back to structures below in the injury site. Particularly, Dr. Shao-chen Zhang at the Second Military University Hospital in Shanghai has a great deal of experience bridging nerves from above the injury site to below the injury site. Dr. Xiao who is also in Shanghai has experience with bridging nerves from below the injury site to the pudendal nerve which innervates the bladder and bowel.

    I don’t know many animal studies that are directly focused on treating cauda equina or conus injuries in animals. I suggest paying attention to research on brachial plexus avulsions because this is the model that is most similar to lumbosacral root injuries.

    Wise.

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    Thanks for detailed reply Dr Young.

    Should i contact Douglas Kerr and Geoffrey Raisman for my injury and treatment? Can you give me the e-mail addresses of them?

    Plz give me e-mail address of Dr Zhang as i could get his opinion too.

    As my injury is 10 years old and also compression fracture of L1 so i think decompression will not be effective now? What you think Dr Young?

    Thanks for being with me always.

    Jawaid

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    Can you plz tell me Dr Young that within how much time treatment of Raisman and Douglas Kerr will be available for patients? Is it possible in near future? How much you sure that these treatments will restore bladder bowel and sexual function in my case?

    What will be ur advise in my case. Should i go china and try Dr Xiao or wait for these treatments to come? Did Xiao ever provide the details of the patients who got bladder bowel recovery?

    Jawaid

  5. #5
    Quote Originally Posted by Jawaid View Post
    Thanks for detailed reply Dr Young.

    Should i contact Douglas Kerr and Geoffrey Raisman for my injury and treatment? Can you give me the e-mail addresses of them?

    Plz give me e-mail address of Dr Zhang as i could get his opinion too.

    As my injury is 10 years old and also compression fracture of L1 so i think decompression will not be effective now? What you think Dr Young?

    Thanks for being with me always.

    Jawaid
    Jawaid,

    None of the researchers that I referred to are working directly on cauda equina or conus injuries but I believe that the therapies that they are working on may be applicable. I thought that you were going to Dr. Xiao? Finally, do you have continuing compression of the L1? If so, I think that you should get decompression.

    Wise.

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    I am willing to go to Dr Xiao but i asked if treatment of Raisman or Kerr are near or they doing then what will be ur suggession?

    Will it be wise to go through decompression after 10 years of injury? I think no expert here in pakistan will do decompression. Whom should i consult for decompression?

    Are Raisman and Kerr doing treatments or will start now? How can i contact them?

    Will Dr Xiao's surgery not work with compression?

    I am really very upset Dr Young. Plz guide what i do

  7. #7
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    Dr Young can you tell me will decompression effect the recovery after Xiao's surgery? Can Xiao's surgery work and recover my functions despite of compression?

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    Dr Young can you plz tell me that is there any doctor doing the same OEG in india which Jeffrey Raisman is doing? If not in india then anywhere else? Raisman needs some years for this treatment so is there any possibility of OEG treatment anywhere in near future for my kind of conus injury? I am sure you will have close eye over this kind of work in china or india.

  9. #9
    Quote Originally Posted by Jawaid View Post
    Dr Young can you plz tell me that is there any doctor doing the same OEG in india which Jeffrey Raisman is doing? If not in india then anywhere else? Raisman needs some years for this treatment so is there any possibility of OEG treatment anywhere in near future for my kind of conus injury? I am sure you will have close eye over this kind of work in china or india.
    As you know, this is not a matter of having doctors will to transplant cells. This is a matter of not having the cells to transplant. OEG research is stuck in the same rut for the last ten years because there is no source of olfactory ensheathing glia that is immune compatible. The group in Brisbane claimed that they were able to grown olfactory ensheathing glia from nasal mucosa, tested it in two patients, and it apparently did not work. I know that Geoffrey Raisman (who is one of the best scientists in the world) has spent the past four years working very hard on trying to develop methods of reliably growing the cells from nasal mucosa without succeeding to date. While it can be done occasionally, the method is just not yet at a point where they can consistently produce large numbers of autologous OEG cells from transplantation.

    Wise.

  10. #10
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    Dear Dr Young

    If it is hard to find OEG cells then do u think that stem cells with combination therapies can give the results to patients like me in the future? What you mean when you say combination of therapies? I mean what other with stem cells?

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