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    #61
    How do I talk a neurosurgeon into doing surgery?
    Alan

    Proofread carefully to see if you any words out.

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      #62
      Originally posted by alan View Post
      How do I talk a neurosurgeon into doing surgery?
      Alan,

      Are you referring to surgery to untether the spinal cord, i.e. removing the adhesions between the spinal cord and surrounding arachnoid membranes? Most neurosurgeons are reluctant to do this operation without clear evidence of progressive deficits that could be attributed to tethering. Several neurosurgeons have reported that untethering of the spinal cord and restoring cerebrospinal fluid flow in the subarachnoid space will improve function in chronic spinal cord injury.

      Wise.

      Comment


        #63
        And what do you two, Wise and Jerry, call the area surrounding my spinal infarct that 4-AP jumped fairly well? With no breakage, smashing, cutting or surgery what happens when just ischemia is present and with such a tiny little thread of damage showing on MRIs which treatment should I be tossing my money at after so many years? Currently I tend to think the Europeans may be closer to a functional recovery trial for some of us that no one mentions like infarcts, cenral cord syndrome and one time TM.
        Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

        Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

        Comment


          #64
          Originally posted by Wise Young View Post
          Alan,

          Are you referring to surgery to untether the spinal cord, i.e. removing the adhesions between the spinal cord and surrounding arachnoid membranes? Most neurosurgeons are reluctant to do this operation without clear evidence of progressive deficits that could be attributed to tethering. Several neurosurgeons have reported that untethering of the spinal cord and restoring cerebrospinal fluid flow in the subarachnoid space will improve function in chronic spinal cord injury.

          Wise.
          Along with the ongoing increases in pains over time, my arms have gotten weaker, and harder to control, and sensation in them changes (right arm faster than left.) The extreme pain in my upper back, along with my sticking shoulder blades, play a role. The neurosurgeons see no tethering on the MRIs, but definite changes in the injured area between 2001 and 2010/11.

          My typing ability is going down the tubes.
          Alan

          Proofread carefully to see if you any words out.

          Comment


            #65
            Dr. Wise a question. My husbands' MRI 4 months post surgery states a high T2 spinal cord signal measuring 7X6mm increased in size compared to prior exam at the level of C4. No cord compression noted. Is this indicative/evidence of gliosis?

            What exactly does this mean and what are the effects on the body? Thank you, for your time.
            Last edited by MichelePaula; 6 Jan 2013, 9:47 PM.

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              #66
              Dr. Silver and Dr. Young: I am extremely interested in seeing each of your's reply to Sue Pendleton's question above (post #63).
              I too had no traumatic injury. Neurologist at University of Texas Medical Center in Dallas told me, in 1997, that a blood vessel had hemorrhaged in the spinal cord. He explained that the resulting inflammation had damaged the cord. I am T10, have not rergaind any sensory and no practical motor (able to move left leg and foot slightly). As Sue said, I would like to know which treatment to support.........thank you, Fred
              Last edited by fourwhlhntr; 6 Jan 2013, 11:06 PM. Reason: to correct post # that I referenced

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                #67
                Originally posted by Sue Pendleton View Post
                And what do you two, Wise and Jerry, call the area surrounding my spinal infarct that 4-AP jumped fairly well? With no breakage, smashing, cutting or surgery what happens when just ischemia is present and with such a tiny little thread of damage showing on MRIs which treatment should I be tossing my money at after so many years? Currently I tend to think the Europeans may be closer to a functional recovery trial for some of us that no one mentions like infarcts, cenral cord syndrome and one time TM.
                Sue,

                Therapies that remyelination and stimulate sprouting surviving axons should also help. Most people who have had infarcts or contusion injuries have some axons going through the injury site. Many of these axons may be demyelinated and inadequately remyelinated. That is probably why 4-aminopyridine helps you. Sprouting of the surviving axons should help because they will make the remaining axons have bigger effects.

                Ultimately, however, you should benefit from regeneration therapies. In ChinaSCINet, we chose to test umbilical cord blood mononuclear cells because they have been reported by many laboratories to improve recovery of function animals when transplanted as late as a week after injury. It is true that these experiments were not chronic spinal cord injury. However, they are not acute injuries either. I don't think that they are protecting the spinal cord. Rather, I hope that they are aiding repair and regeneration.

                Lithium stimulates neural stem cells to grow and axons to regrow in animal studies. It also increased neurotrophin production in the spinal cord transplanted with umbilical cord blood mononuclear cells. Therefore, we are hoping that the combination of the two therapies will be beneficial in chronic spinal cord injury. Our phase II trials have given us sufficient reason, in my opinion, to go ahead with Phase III trials. If the phase III trials indicates that umbilical cord blood mononuclear cells with or without lithium are ineffective, we will say that it doesn't help and go on to other therapies.

                If the umbilical cord blood and lithium combination therapy stimulates regeneration and improves function, it should be beneficial for ischemic infarcts, transverse myelitis, and other inflammatory diseases of the spinal cord. We hope that others will start testing the therapy in more clinical trials of people with different types of injuries.

                Wise.

                Comment


                  #68
                  Originally posted by alan View Post
                  Along with the ongoing increases in pains over time, my arms have gotten weaker, and harder to control, and sensation in them changes (right arm faster than left.) The extreme pain in my upper back, along with my sticking shoulder blades, play a role. The neurosurgeons see no tethering on the MRIs, but definite changes in the injured area between 2001 and 2010/11.

                  My typing ability is going down the tubes.
                  Alan,

                  I just came back from China and have been reviewing data from the Kunming group. Over the years, they have done over 300 untethering surgeries of the spinal cord and I hope that we can get that study published. What you describe sounds very much like tethering of the spinal cord. I also know from having observed cases of chronic spinal cord injury that MRI's often cannot show tethering. They have one case of a woman who had a very severe spinal cord injury and nothing improved her recovery for two years until they did an untethering surgery. Now, her pain is mostly gone and she is recovering motor function.

                  Wise.

                  Comment


                    #69
                    Originally posted by fourwhlhntr View Post
                    Dr. Silver and Dr. Young: I am extremely interested in seeing each of your's reply to Sue Pendleton's question above (post #63).
                    I too had no traumatic injury. Neurologist at University of Texas Medical Center in Dallas told me, in 1997, that a blood vessel had hemorrhaged in the spinal cord. He explained that the resulting inflammation had damaged the cord. I am T10, have not rergaind any sensory and no practical motor (able to move left leg and foot slightly). As Sue said, I would like to know which treatment to support.........thank you, Fred
                    hi, fourwhlhntr, please see my post to Sue Pendleton. If they show beneficial effects, I believe that the trials in which we are now testing in traumatic spinal cord injury should be relevant to transverse myelitis, ischemia, hemorrhagic, and other causes of non-traumatic spinal cord injury. Wise.

                    Comment


                      #70
                      Originally posted by Wise Young View Post
                      I just came back from China and have been reviewing data from the Kunming group. Over the years, they have done over 300 untethering surgeries of the spinal cord and I hope that we can get that study published. What you describe sounds very much like tethering of the spinal cord. I also know from having observed cases of chronic spinal cord injury that MRI's often cannot show tethering. They have one case of a woman who had a very severe spinal cord injury and nothing improved her recovery for two years until they did an untethering surgery. Now, her pain is mostly gone and she is recovering motor function.

                      Wise.
                      Wise, appoligies for crossing over forums, but I just had a query regarding the reduced pain following untethering surgery in your response above. Firstly, I assume you're referring to neuropathic (central) pain. I'm a T10 complete from a trauma 6 year ago and suffer pretty bad NP. I've tried all of the typical medications and the only relief I'm getting at the moment is Fentynal patches. I while ago I had an MRI for a trial stimulator implant (which was unsuccessful), and the MRI showed a small cavity which at first was thought to be a syrinx, but my original surgeon reviewed it and convinced me it that the cavity was present immediately following my injury. My question is, if the MRI doesn't necessarily detect tethering, is there anything we can do to determine if the untethering procedure is likely to help with NP apart from the trial and error of surgery itself.

                      Thanks,
                      Clayton
                      "Wheelie Wanna Walk!"

                      Comment


                        #71
                        Originally posted by Geoman View Post
                        Wise, appoligies for crossing over forums, but I just had a query regarding the reduced pain following untethering surgery in your response above. Firstly, I assume you're referring to neuropathic (central) pain. I'm a T10 complete from a trauma 6 year ago and suffer pretty bad NP. I've tried all of the typical medications and the only relief I'm getting at the moment is Fentynal patches. I while ago I had an MRI for a trial stimulator implant (which was unsuccessful), and the MRI showed a small cavity which at first was thought to be a syrinx, but my original surgeon reviewed it and convinced me it that the cavity was present immediately following my injury. My question is, if the MRI doesn't necessarily detect tethering, is there anything we can do to determine if the untethering procedure is likely to help with NP apart from the trial and error of surgery itself.

                        Thanks,
                        Clayton
                        Clayton,

                        Dr. Yansheng Liu probably has more experience operating on chronic spinal cord injury than anybody I know. He says that every case is different and he tells his patients that he cannot predict which cases will improve. The goal of his surgery is to relieve all constrictions, remove adhesions between the spinal cord and surrounding tissues, and restore cerebrospinal fluid flow. Thankfully, none of his patients have gotten worse from the surgery.

                        Dr. Liu and Dr. Zhu have agreed to organize all the untethering cases that their team has done over the years and I have agreed to help them write it up. We will try to do this as soon as possible. We also discussed the control group in the phase III study and agreed that it should consist of untethering surgery without injection of cells into the spinal cord. This is only possible if we have evidence that the surgery alone has some benefit.

                        When the MRI shows a constriction or compression of the spinal cord, that usually means tethering. Normally, there should be cerebrospinal fluid all around the spinal cord. If the spinal cord is not constricted or compressed but still consistently touching one side, this suggests tethering. Ever since they found that opening up the dura of subacute spinal cord injury cases improves recovery in patients classified as ASIA A, they have been exposing many spinal cords.

                        But, in answer to your question, while MRI's can show evidence of tethering, it sometimes does not show anything suspicious and then surgery reveals tethering or vice versa. There are no guarantees that the untethering will reduce neuropathic pain or will restore function. I don't know what the percentages of recovery are in his series. I guess that when we compile the data, we will find out.

                        Wise.,

                        Comment


                          #72
                          Thanks again Wise.

                          Clayton
                          "Wheelie Wanna Walk!"

                          Comment


                            #73
                            Originally posted by Wise Young View Post
                            Alan,

                            I just came back from China and have been reviewing data from the Kunming group. Over the years, they have done over 300 untethering surgeries of the spinal cord and I hope that we can get that study published. What you describe sounds very much like tethering of the spinal cord. I also know from having observed cases of chronic spinal cord injury that MRI's often cannot show tethering. They have one case of a woman who had a very severe spinal cord injury and nothing improved her recovery for two years until they did an untethering surgery. Now, her pain is mostly gone and she is recovering motor function.

                            Wise.
                            You've written before that tethering is often not visible on MRI, and I said that to the doctor when I saw him, but he still was against surgery.
                            Alan

                            Proofread carefully to see if you any words out.

                            Comment


                              #74
                              Dr. Young, when you have time, could you describe what a glial scar looks like in an injured spinal cord of a human. Is it a thin membrane? Clear, opaic, brown? Is it thick and hard like the scar on skin? Does it completely surround the spinal cord? Can it be cut/sliced and then unwrapped by a surgeon? Could the scar be weakened and thined out by using some sort of abrasive (thinking of something like sandpaper)?

                              Maybe Jerry Silver could comment on these same questions in relationship to the mice/rats spinal cords that have been seen his lab. Jerry did mention that the glial scar does get smaller (thinner?) as the years go by for chronic SCI.

                              Bless you both for your lifetimes of hard work and sacrifices to help SCI's eventually get out of these chairs and recover function.
                              Last edited by 6 Shooter; 18 Jan 2013, 4:17 PM.

                              Comment


                                #75
                                Originally posted by alan View Post
                                You've written before that tethering is often not visible on MRI, and I said that to the doctor when I saw him, but he still was against surgery.
                                Alan, I know. Neurosurgeons are conservative. I am not sure why but I think that very few of them have exposed a chronically injured spinal cord and, if they do, it must be for a good reason. Otherwise, if a patient gets worse after surgery, he will be blamed for doing an unnecessary surgery.

                                Wise.

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