Restoring Function After Spinal Cord Injury With Nerve Transplant: The New Frontier

Written by Laura Dyrda | September 22, 2011 | Print  |
As of yet, scientists and researchers have not been able to completely reverse the damage caused by spinal cord injury, but a core group of experts in this fast-moving field have been making advances with therapies that can return function and make life easier for SCI patients. On Nov. 5, the Institute for Advanced Reconstruction at The Plastic Surgery Center in Shrewsbury, N.J., will be hosting a symposium for medical professionals to discuss advancement in treatment for SCI patients. "At the Institute for Advanced Reconstruction, we do things like nerve transplant, re-intubation of the diaphragm for ventilator-dependent patients and therapies to help spinal cord injury patients regain function," says Andrew Elkwood, MD, chairman and founder of The Institute for the Treatment of Paralysis, Jersey Shore Medical Center, N.J., where the symposium will take place. "We deal with everything from nerves to torso and diaphragm issues. We see SCI patients and stroke patients, which means the patients we see crossover with the orthopedic patient population."

Several surgeons from the Institute for Advanced Reconstruction will be speaking at the seminar, along with Wise Young, MD, a surgeon at NYU Langone Medical Center and director of W.M. Keck Center for Collaborative Neurosciences at Rutgers University, and renowned Chinese surgeon Shaocheng Zhang, MD, professor and chief surgeon in the department of orthopedics at Changhai Hospital in Shanghai. Dr. Zhang uses a unique technique for nerve transplantation, which he will continue to share with American surgeons upon his visit, his first to this country.

Nerve transplantation

The nerve transplantation technique Dr. Zhang performs includes multiple procedures to reroute peripheral nerves and restore function for SCI patients. Surgeons connect the rerouted nerves to a different nerve through multiple arrangements. For example, a common procedure includes rerouting an intercostal nerve from the spinal cord around each rib to the sternum before reaching the target nerve site below the injured level of the spine. In cases where the intercostal nerve is not long enough to reach the target nerve, a sural nerve segment can be attached.

Dr. Zhang has also experienced success rerouting the nerves from the damaged site to other peripheral nerves, such as the ulnar nerve, when the injury site is above the thoracic area where intercostal nerves originate. This technique has been able to restore function for patients with virtually any level of injury: for high-level injury sites, the surgeon can connect functional peripheral nerves above the injury site to nearby dysfunctional nerves below the injury site.

"We're looking forward to meeting with Dr. Zhang and learning from him," says Dr. Elkwood. "It's really exciting to have him visit us. We're hoping to collaborate with him — we already do many of the things he does, but we want to do collaborative studies."

Dr. Elkwood and his colleagues also hope to make a trip to China in the future to collaborate with Dr. Zhang and learn more about the surgical technique.

What the evidence says

Part of the reason why more surgeons in the United States don't perform nerve transplantation or take on Dr. Zhang's techniques is because the western country has stricter regulations than the eastern country. For better or for worse, these regulations make it hard to bring new products and procedures to the U.S. market that could potentially be very beneficial to patients.

"In certain respects, China lags behind the United States with providing medical care, but in other respects the regulations in China are looser so the field can progress more quickly," says Dr. Elkwood. "There are some procedures we are able to do that are very cutting edge and others that are pretty standard, but everything we do is under utilized in this country, which is really a shame. There are some procedures that have been around for a long time, but surgeons still aren't using them, which bothers us tremendously."

While advancement in the field is always encouraged, surgeons must also take time to show their new techniques are beneficial through evidence-based research. Dr. Zhang and his colleagues have been able to report on the results of his nerve transplantation technique in 23 patients, who received 2-4 intercostal nerves transferred to the vertebral canal through a submuscular tunnel and connected to lumbar nerve roots. All patients were traumatically injured between thoracic T9-T12 levels and had sustained the injury six to 30 months prior to surgery. There were 18 of the patients who were able to regain some ambulatory function, which allowed them to walk with crutches or another assistive device.

In an additional study, Dr. Zhang and his colleagues examined the use of an intercostal-sural nerve bridge to restore some bladder and bowel functions for SCI patients. During this procedure, the surgeons transferred two intercostal nerves above the injury site to the vertebral canal through a submuscular tunnel, sutured a sural nerve segment to the intercostal nerves and then to the S2-4 nerve roots. There were 30 patients who participated in this study and bladder and bowel function was restored for most patients.

Future

As the research into SCI evolves, more physicians and medical professionals will be able to use new technology to help patients after they sustain a traumatic injury. However, for now it's important for professionals at the forefront of the field to work with medical professionals and spread the word about what is available for their patients.

"Orthopedists are often the first specialists to see patients with traumatic injuries and peripheral nerve conditions," says Dr. Elkwood. "Our field of nerve transplantation crosses between orthopedics, spine, neurosurgery and microsurgery. We have some new procedures, but most have been around for several years and we still see patients who haven't received the proper treatment. We need to reach out to the medical community because all clinicians need to know about what is out there for these patients."

Learn more about the Institute for Advanced Reconstruction.


To learn more about the seminar and register, click here.

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