Nerve Transplant for Paraplegic Patients After Spinal Cord Injury: Q&A With Dr. Andrew Elkwood


Andrew Elkwood, MD, and his colleagues are currently working on a study of performing nerve graft transplantation using allograft or autograft tendon to restore extremities function in paraplegic patients after spinal cord injury, central nervous system insult or stroke. The study was approved on Nov. 18, 2011 and will follow patients for 12 months after surgery. Here, Dr. Elkwood discusses the procedure and his research going forward.
Q: What are you aiming to accomplish with this clinical trial?

Dr. Andrew Elkwood:
We are conducting clinical trials for the treatment of patients with a paralysis, such as spinal cord injury or stroke. In the trial we are using techniques traditionally used to treat peripheral nerve paralysis elsewhere in the body and applying them toward these cases. We are using nerve grafting techniques in conjunction with the standard tendon transfer and joint fusion techniques.

Q: Why are you able to successfully transfer and combine these techniques when treating patients?

AE: The problem both paraplegic patients and peripheral nerve damage patients have is very similar in some respects. Paraplegic patients often have spastic paralysis whereas peripheral nerve patients have flaccid paralysis. Spastic paralysis occurs when muscles don't move because they are contracted so severely, which makes the condition very difficult. The first thing we have to do is convert the spastic paralysis into flaccid paralysis. You can perform a procedure to cut the nerves sending messages to the spastic muscles and reattach them to convert the paralysis.

What we do from there are tried-and-true techniques for nerve paralysis: nerve grafting, tendon transfers, joint fusions and neurotizations. I've done a lot of these procedures for flaccid paralysis and now I'm beginning to perform them on patients with spastic paralysis. We're hoping we can improve the functions of these patients.

Q: How does this research fit into the body of literature and treatment for paraplegics?

AE: It should be another weapon in the armamentarium for the treatment of these patients. It's not a cure — we aren't reversing spinal cord injury. We are trying to maximize function in patients who have experienced this trauma. The procedure doesn't supplant stem cells or regenerate nerves. We are treating individual patients and improving their function going forward. It's making their lives better; as clinicians, that's our goal.

Q: Where does the research for patients with paralysis go from here?

AE: There is a lot of work being done on things like stem cell research, which may have an impact on peripheral nerve surgery. Here, we are using a peripheral nerve approach for a central nerve problem. They are separate, but obviously related.

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