Announcement

Collapse
No announcement yet.

ChinaSCINet Update

Collapse
This is a sticky topic.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    Originally posted by Barrington314mx View Post
    why would you NOT do the intradural decompression while ur already in there on chronics? couldnt that effect results negatively if the cord is still compressed?
    Barrington, there is no reason to decompress the chronically injured cord! There is no pressure in the chronically injured spinal cord. Wise.

    Comment


      Originally posted by Wise Young View Post
      Barrington, there is no reason to decompress the chronically injured cord! There is no pressure in the chronically injured spinal cord. Wise.
      sorry, i just don't understand this. excuse my ignorance. what causes the pressure of the cord to begin with? and how does that pressure subside? in my original surgery when they put the rods in?

      Comment


        Originally posted by Barrington314mx View Post
        sorry, i just don't understand this. excuse my ignorance. what causes the pressure of the cord to begin with? and how does that pressure subside? in my original surgery when they put the rods in?
        This is not an answer to your question, but an answer to a related question I had, i.e. "Why not always decompress?"

        /forum/showpost.php?p=64725&postcount=2

        Comment


          Originally posted by Barrington314mx View Post
          sorry, i just don't understand this. excuse my ignorance. what causes the pressure of the cord to begin with? and how does that pressure subside? in my original surgery when they put the rods in?
          For several days or even weeks after injury, the spinal cord swells. The swelling results from cellular swelling. The pressure inside the spinal cord increase with swelling. When the pressure inside the spinal cord approaches or exceeds blood pressure in the arteries, blood flow slows or stops. This only occurs in acute and subacute spinal cord injury.

          Intradural decompression was developed and used by Dr. Zhu Hui and her team at the Kunming Army General to relieve pressure inside the spinal cord due to swelling in the days and weeks after spinal cord injury. Usually, in the United States, when they talk about decompression, they are referring to removing bone or disc compressing the spinal cord. They do not do intradural decompression in the U.S.

          In chronic spinal cord injury, the injury site is no longer swollen. There is no pressure at the injury site. Therefore, there is no reason to decompress.

          Wise.

          Comment


            Originally posted by khmorgan View Post
            This is not an answer to your question, but an answer to a related question I had, i.e. "Why not always decompress?"

            /forum/showpost.php?p=64725&postcount=2
            I am afraid that we are mixing several issues. In the post that you referred to, I was saying that if there is something extradurally compressing the spinal cord (whether the person has an incomplete or complete spinal cord injury), the surgeons should decompress.

            Barrington314mx was asking about intradural decompression of chronic spinal cord injury. I said that chronic injured spinal cords do not have edema and therefore there is no reason to do intradural decompression of those spinal cords.

            Wise.

            Comment


              Originally posted by Wise Young View Post
              Intradural decompression was developed and used by Dr. Zhu Hui and her team at the Kunming Army General to relieve pressure inside the spinal cord due to swelling in the days and weeks after spinal cord injury. Usually, in the United States, when they talk about decompression, they are referring to removing bone or disc compressing the spinal cord. They do not do intradural decompression in the U.S.

              Wise.
              Why is this not done in the U.S.? Are surgeons here not trained to do that, Dr. Wise?

              Comment


                Originally posted by debbie1341 View Post
                Why is this not done in the U.S.? Are surgeons here not trained to do that, Dr. Wise?
                Debbie,

                Zhu Hui tried to publish this work in U.S. neurosurgery journals and they turned the paper down, saying that they don't believe the work.

                We have brought several U.S. surgeons to China to observe the procedure and they think that they can do the procedure. But, for the procedure to be adopted in America and Europe, phase 3 trials must be done to demonstrate the safety and efficacy of the procedure.

                So, we are trying now to organize a phase 3 randomized clinical trial in China to test the procedure rigorously.

                Wise.

                Comment


                  wise,
                  i have sci at c6-c7 since feb-2008. my present situation is my upper limbs are functioning good (90% as compred to normal person.), and i can feel the touch in my lower limbs and sometimes use reflexes according to my needs.. but i viewed your videos and got a hope i can walk again and live a normal life. what i am looking for is, where to get this stem cell therapy... will u treat patients in india or we have to come to china or somewhere else..??
                  thanks a lot for rising hope to all the people with SCI.

                  Comment


                    Originally posted by Wise Young View Post
                    Debbie,

                    Zhu Hui tried to publish this work in U.S. neurosurgery journals and they turned the paper down, saying that they don't believe the work.

                    We have brought several U.S. surgeons to China to observe the procedure and they think that they can do the procedure. But, for the procedure to be adopted in America and Europe, phase 3 trials must be done to demonstrate the safety and efficacy of the procedure.

                    So, we are trying now to organize a phase 3 randomized clinical trial in China to test the procedure rigorously.

                    Wise.
                    Thank you for your answer, doctor.
                    I wish this had been an option 3 years ago when my husband was injured. He never had any kind of decompression, his doctor said he didn't need it.
                    Every chronic is an acute at one time.
                    If injuries could be lessened with this type of procedure, that could mean more resources for chronic injuries.
                    Debbie

                    Comment


                      Originally posted by inderpreet View Post
                      wise,
                      i have sci at c6-c7 since feb-2008. my present situation is my upper limbs are functioning good (90% as compred to normal person.), and i can feel the touch in my lower limbs and sometimes use reflexes according to my needs.. but i viewed your videos and got a hope i can walk again and live a normal life. what i am looking for is, where to get this stem cell therapy... will u treat patients in india or we have to come to china or somewhere else..??
                      thanks a lot for rising hope to all the people with SCI.
                      I am continuing to discuss the possibility of doing a trial in 2013 in India with colleagues in India. I hope that we will do the trial in India. Much depends on whether or not we can get the funding.

                      Wise.

                      Comment


                        Originally posted by debbie1341 View Post
                        Thank you for your answer, doctor.
                        I wish this had been an option 3 years ago when my husband was injured. He never had any kind of decompression, his doctor said he didn't need it.
                        Every chronic is an acute at one time.
                        If injuries could be lessened with this type of procedure, that could mean more resources for chronic injuries.
                        Debbie
                        Yes, and every acute becomes a chronic.

                        I had spent the first half of my career doing clinical trials of therapies for acute spinal cord injury, including methylprednisolone, naloxone, and tirilazad mesylate. Of these, methylprednisolone was the best and had the most significant effects. Since 1997, although I have focused most of my effort on chronic spinal cord injury. However, in recent years, I have become quite distressed by the lack of progress in the acute spinal cord injury therapy field. Methylprednisolone is a drug that I started testing in 1979.

                        To have no other treatment for acute spinal cord injury better than methylprednisolone in 35 years is a travesty. Fortunately, at the recent Neurotrauma Society meeting in Phoenix, it appears that several therapies are beginning to emerge. Clinical trials testing minocycline and riluzole are beginning to show positive results. Even more interesting, the STASCIS trial showed that the best results are in patients that were treated with decompression and methjylprednisolone.

                        Acute spinal cord injury therapies are important for one other perspective and that is to protect the cell transplant and the spinal cord during the transplant procedure. A single bolus of 30 mg/kg methylprednisolone significantly improves survival of transplanted cells in animal spinal cords. So, one of the arms of our clinical trial was looking at this.

                        Wise.

                        Comment


                          Originally posted by Wise Young View Post
                          Yes, and every acute becomes a chronic.

                          I had spent the first half of my career doing clinical trials of therapies for acute spinal cord injury, including methylprednisolone, naloxone, and tirilazad mesylate. Of these, methylprednisolone was the best and had the most significant effects. Since 1997, although I have focused most of my effort on chronic spinal cord injury. However, in recent years, I have become quite distressed by the lack of progress in the acute spinal cord injury therapy field. Methylprednisolone is a drug that I started testing in 1979.

                          To have no other treatment for acute spinal cord injury better than methylprednisolone in 35 years is a travesty. Fortunately, at the recent Neurotrauma Society meeting in Phoenix, it appears that several therapies are beginning to emerge. Clinical trials testing minocycline and riluzole are beginning to show positive results. Even more interesting, the STASCIS trial showed that the best results are in patients that were treated with decompression and methjylprednisolone.

                          Acute spinal cord injury therapies are important for one other perspective and that is to protect the cell transplant and the spinal cord during the transplant procedure. A single bolus of 30 mg/kg methylprednisolone significantly improves survival of transplanted cells in animal spinal cords. So, one of the arms of our clinical trial was looking at this.

                          Wise.
                          Wise,

                          are you saying that your focus shifted back to acute SCI?

                          I have seen/heard you talking a lot about acute SCI in the last few years and I have been wondering why you paid so much attention to acute SCI...

                          An SCI researcher recently told me that, at the moment, doing chronic studies the chances of success are very low and since scientists need to show some success to stay in business they tend to stay on acute SCI where at least some limited recovery is easy to show... especially when dealing with a mild SCI..

                          I think that if chronic SCI had been studied as much as acute SCI we could be walking since the chronic setting is less complex therefore, possibly, easyer to solve.

                          Paolo
                          In God we trust; all others bring data. - Edwards Deming

                          Comment


                            Originally posted by paolocipolla View Post
                            Wise,

                            are you saying that your focus shifted back to acute SCI?

                            I have seen/heard you talking a lot about acute SCI in the last few years and I have been wondering why you paid so much attention to acute SCI...

                            An SCI researcher recently told me that, at the moment, doing chronic studies the chances of success are very low and since scientists need to show some success to stay in business they tend to stay on acute SCI where at least some limited recovery is easy to show... especially when dealing with a mild SCI..

                            I think that if chronic SCI had been studied as much as acute SCI we could be walking since the chronic setting is less complex therefore, possibly, easyer to solve.

                            Paolo
                            Paolo,

                            We are doing chronic spinal cord injury clinical trials. I am saying that the field also needs acute spinal cord injury trials. It is terrible that after 30 years, the treatment that we discovered in 1979, i.e. methylprednisolone, for acute spinal cord injury is still the only one. I encourage acute spinal cord injury studies as well as chronic spinal cord injury.

                            In my opinion, I think that you are wrong to attack scientists who do acute spinal cord injury work. By the way, I don't know who the scientist is who said that acute spinal cord injury therapies are easier to achieve. If it were so easy, you would think that we would have dozens of therapies besides methylprednisolone after 30 years. In fact, acute spinal cord injury clinical trials are very difficult to do.

                            If confirmed, the intradural decompression of the spinal cord is potentially the best acute spinal cord injury therapy to date. It restores walking to about 50% of people with ASIA A spinal cord injury. Many neurosurgeons in the United States don't believe these results and the only way to convince them is to do a rigorous multicenter clinical trial. We are helping our colleagues in China do this.

                            This does not change my commitment to chronic spinal cord injury.

                            Wise.

                            Comment


                              I moved several posts to the Members Only Forum that had nothing to do with ChinaSCINet.

                              Comment


                                Dr. Young,
                                Your above post talks about the intradural decompression. I had a bone fragment pressing on my spinal cord that was removed about 24 hours after my injury. My dura was torn and repaired. Is this the surgery you are talking about?

                                Comment

                                Working...
                                X