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  • New surgical approach for late complications from spinal cord injury

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    ABSTRACT: BACKGROUND: The most frequent late complications in spinal cord injury result from arachnoiditis and consequent alterations in dynamics of cerebrospinal fluid flow. A surgical procedure carried out on patients with these alterations, resolved the various pathologies more efficiently in all cases. METHODS: From October 2000 to March 2006, 23 patients were selected for surgery: three showed signs of syringomyelia, three presented with microcystic lesions, three presented with arachnoid cysts in different locations but always confluent to the scar area, and 14 showed evidence of tethered cords. The surgery consisted of laminectomy at four levels, followed by dural opening in order to remove all the arachnoiditis at the level of the scar and to remove the altered arachnoid and its cysts, at least at two levels above and below the lesion. The dentate ligaments were cut at all exposed levels. RESULTS: The patients had no postoperative problems and not only retained all neurological functions but also showed neurological recovery. According to the motor and sensory scale of the American Spinal Injury Association, the recoveries were motor 20.6% (P <0.001), touch 15.6% ((P <0.001) and pinprick 14.4% (P <0.001). These patients showed no signs of relapse at 4-66 month follow-up. CONCLUSIONS: This alternative surgery resolved the pathologies provoking neurological deterioration by releasing the complete spinal cord at the level of the scar and the levels above and below it. It thus avoids myelotomies and the use of shunts and stents, which have a high long-term failure rate and consequent relapses. Nevertheless, this surgical procedure allows patients the chance to opt for any further treatment that may evolve in the future.
    PMID: 17059598 [PubMed - as supplied by publisher]

  • #2
    Here is the full abstract, authors, and URL address
    [*] Reis AJ (2006). New surgical approach for late complications from spinal cord inju. BMC Surg 6: 12. ABSTRACT: BACKGROUND: The most frequent late complications in spinal cord injury result from arachnoiditis and consequent alterations in dynamics of cerebrospinal fluid flow. A surgical procedure carried out on patients with these alterations, resolved the various pathologies more efficiently in all cases. METHODS: From October 2000 to March 2006, 23 patients were selected for surgery: three showed signs of syringomyelia, three presented with microcystic lesions, three presented with arachnoid cysts in different locations but always confluent to the scar area, and 14 showed evidence of tethered cords. The surgery consisted of laminectomy at four levels, followed by dural opening in order to remove all the arachnoiditis at the level of the scar and to remove the altered arachnoid and its cysts, at least at two levels above and below the lesion. The dentate ligaments were cut at all exposed levels. RESULTS: The patients had no postoperative problems and not only retained all neurological functions but also showed neurological recovery. According to the motor and sensory scale of the American Spinal Injury Association, the recoveries were motor 20.6% (P <0.001), touch 15.6% ((P <0.001) and pinprick 14.4% (P <0.001). These patients showed no signs of relapse at 4-66 month follow-up. CONCLUSIONS: This alternative surgery resolved the pathologies provoking neurological deterioration by releasing the complete spinal cord at the level of the scar and the levels above and below it. It thus avoids myelotomies and the use of shunts and stents, which have a high long-term failure rate and consequent relapses. Nevertheless, this surgical procedure allows patients the chance to opt for any further treatment that may evolve in the future. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17059598

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    • #3
      Another hope

      Hello

      You must see this article " New approach for late complications from spinal cord injury" by Dr Antonio Reis
      http://www.biomedcentral.com/content...-2482-6-12.pdf

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      • #4
        Originally posted by Nina-1964
        Hello

        You must see this article " New approach for late complications from spinal cord injury" by Dr Antonio Reis
        http://www.biomedcentral.com/content...-2482-6-12.pdf
        Nina-1964, I merged the topics together, since they are of the same paper. Thank you for posting the full article. Wise.

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        • #5
          New hope

          I have a car accident in July 2003, in cause of this a lesion C6 C7.
          3 weeks ago i performed this new surgery with Dr. Reis. The results are amazing, and very good. My movements in arms and hands are increase 30%. The sensations in all body is better day after day.
          This surgery open a new hope in my life, i have 46 years old and i refuse loose my faith in shearch a cure.

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          • #6
            Dr. Young, Would a cyst also be considered a syrinx?
            Thank you, Mary
            "Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not." ~ Dr. Suess

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            • #7
              Cool Pictures!

              The pictures of surgery in the .pdf are so cool! I have never seen the spinal cord and always wondered what it looks like. I always thought it was liquid inside the dura!
              You can clearly see a little bit of the cord is damaged.

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              • #8
                Originally posted by MHemenway
                Dr. Young, Would a cyst also be considered a syrinx?
                Thank you, Mary
                Mary,

                A syringomyelic cyst (syrinx) is an expansion of the spinal canal which is situated in the middle of the spinal cord. A syrinx is located inside the spinal cord, should have a membrane surrounding, and often extends longitudinally up and down the spinal cord. Therefore, the syrinx is also inside the spinal cord.

                There are other kinds of cyts. These include a epidural cyst which is a cyst on the outside of the dura, an arachnoid cyst which is a cyst of the arachnoid membranes located just inside the dura.

                Wise.

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                • #9
                  I wish there was a place to get rid of my tethering & they could add some ESC or something.
                  "Some people say that, the longer you go the better it gets the more you get used to it, I'm actually finding the opposite is true."

                  -Christopher Reeve on his Paralysis

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                  • #10
                    Dr WISE
                    Whatis this: "medullar hyperintensity" and "medullar expansion"?
                    Is this "medullar repair"?
                    (Sorry my english)

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                    • #11
                      evidences - new hope

                      Hello, I greet you to all of the community CareCure,

                      my name is José Antunes and I am here to give you an evidence on my friend Isidro, paraplegic, father of 2 girls and at present in a process of divorce.

                      Without being a doctor and not knowing the technical terms of this complex reality that is our nervous system, I will try to describe you in common language completely what went on, but this is not a novel, like you well you know, a history of sanctity or of miracles.

                      In 2003, he had a serious accident in a van in Spain, Zaragoza, when he was going for an activity of scouts in Switzerland. The tire burst and it ran 200 meters to the tumbles, having finished the distance in the ditch of separation of the highroad. After the recuperation of the life, the reality might not crueller being: it was immobilized, apparently tetraplegic. It was transferred to Portugal of helicopter to Garcia da Horta Hospital; survived these 3 years between hospital, Alcoitão - centre of recuperation and finally, it found a more stable "home" in the Military Home of the Red Cross. It recovered some mobility in the arms, though very reduced and it was totally dependent.

                      My biggest shock went to see it in Zaragoza there are 3 years, tied to a bed, saying that it wanted to put an end to the life.

                      The whole his life was dedicated to activities of scouts, local and national, by a man full of life, intelligent and lover of the small pleasures of the life. Now, even for me it was too sad and distressing to see it in those conditions. I still do not even dream what is a person to be without being able to move, without autonomy and dependant of others, losing part of his dignity with the investigation of his intimacy. That in the activities we simulate the same situations to move the young persons for these difficulties of others, to pass by them it is still, I judge, a dose of courage and of almost supernatural effort.

                      Very often I spent these 3 dejected and sad years, in the days in which he was going to see it, when there are realizing the more and more definite reality and prisoner of a bed or a wheelchair. In this point, I am not able to hide very much my emotions and it was often that the family was realizing that in the reserve you surprise the life bitter. The search of something that could alter the state of the situation was a ray of light in a way that it helped to show who the truthful friends were, that what were maintained on his side in the most difficult hours.

                      Some alterations took place in the life of my friend and the fact of being still lucid and working for the enterprise in the management of the fleet of vehicles, it allowed that it was improving the conditions for his mobility: the purchase of an electric wheelchair and the purchase of a van adapted with electric platform. In the processes of recuperation they it were making his inquiry travel in the Internet and checking conditions for his dislocation, behind a flame of hope: Tocha-Portugal, Cuba, Russia, Afghanistan, England, the United States... I tied to one common friend who was working in the medical emergence-INEM, António Matos, of Inhabitant of Coimbra, to validate some options, between which of the Torch and Cuba. The reality was still very naked and raw as for recuperation.

                      My friend Conceição Costa, a woman full of life and mother of 3 children, talked to me in case of a common friend, federate gymnast, who had kept in the same conditions of paraplegia mobility, while jumping of trampoline in proofs of gymnastics. Now it was already in a phase of recuperation and beginning his distance of crutches. The hope was relit in my mind and I asked for him the contact of the doctor. I talked to Isidro of this hypothesis and talked with the family on this potential opportunity. The confirmation of all encouraged me to go to the primira it consults with Dr. Reis in the Red Cross Hospital. So we did it, with the help of the newest brother, Carlos.

                      The first meeting it left hope on air, though Isidro was not silent a moment to explain to a doctor all the techniques and places of the world where experiences were done in this area. The doctor was hearing with much patience and warding off with practical examples of what it was necessary to do from immediate one and in the short term. I marked the examinations what it recommended of TAC and myelo TAC and there we were an again in the preliminary distance of diagnosis, in the centre recommended by the doctor, since that was the most specialized thing in Lisbon in these auxiliary ways of diagnosis and which good display the interior of our cervical structure. When the auxiliary ways of diagnosis were gathered, it was a pleasant surprise to check that my friend was finding in perfect conditions to begin a process of recuperation as soon as if it was checking had not been cut of the marrow.

                      He had a few tumors that were pressing the marrow against the column, conformable it was showing the TAC, as well as the whole physical deformation for the foul position assumed along the time. It explained Doctor Reis whom his methodology nothing had to do with other situations and was not doing miracles: it was hardly creating conditions work the marrow again and of everything preparing for the process of recuperation.

                      The encouragement did not cease and was on air the challenge of the operation for the end of the September. More, which he said to my friend, if it accepted the challenge, was still that it worse could not be, but more important, there was no step of return. Dressing what the essential of the relation of confidence between the doctor and the patient reveals himself in these essential opportunities in our life.

                      It was still necessary the whole battery of examinations and medical validations, from the blood even to the anaesthesia. Completely validated, it happened what paradoxically, there had more health than a great deal of us with total mobility. It began the preoperative physiotherapy with the objective to improve the conditions of breathing and speech, as well as of preparing the column to work in the post-operative one. The physiotherapist Graça Mendes was occupied specially of giving gymnastics to an inert body, exercising hands, arms and column to allow some flexibility.

                      One week before, I met with Doctor Reis in the Hotel Marriot to talk to him in the project Step by Step and it allowed a lively conversation to realize better the whole surgery and of what it the question was at last innovator in this so delicate area, even between the medical class. The great expectation was then the official publication of his work and international recognition of something that led a whole life of dedication and suffering. I learnt more in 2 hours that in half of my life and me it made feel very little in my experience of life.

                      The great day arrived: 10 of October of 2006. I went to the Home in the morning, 9:30 A.M.. Isidro was looking well, apprehensively and nervously. It had treated already everything, inclusive his legal and testamental arrangements (the doctor was shocked when he knew of this situation!). I took it to the hospital of Sant'Ana, in the Wall, that one what in the opinion of the doctor Reis it had better conditions in the recuperation of powders operating. I met with 2 brothers, Luís and Carlos, on the way of the hospital, in Oeiras. It was good, especially for the support felt in that hour of change of life and hope. Other friends were phoning expressing votes of success and encouraging.

                      We submitted in the administrative services of the hospital and Isidro was driven to the room. Beginning happened to the period of preparation of the operation properly stated and we leave from there, it was 11:30 A.M.. The surgery began for 14:00 P.M and lasted even to 17:00, except my mistake of imprecision. For 18:30 P.M. I tied to Doctor Reis and the news were the best: though it had found some complications by the way, a vertebra was broken and pressing the marrow, the conditions of the marrow were in perfect state to begin the process of recuperation.

                      The next day, my friend Isidro tied me for 8h30 A.M. to say that it woke up! It was completely well and to warn the friends. To the end of the morning there I went to visit it and which is not my fright, already to feel it the body lightly and slowly to recover the sensations: it was already placing the feet in the bed, supporting totally the plant of the feet and finger pressure of the physiotherapist, Graça, were leaving him sensations already extended in the time. I had the opportunity for exchanging some impressions on the results with the medical Doctor Reis and of the things that still today I have in the mind it is his great maxim,
                      "we are always learning in the life, the road of the success is always a way works".

                      The next days were a cheerful and confused awakening for the life, again. In the next Monday to the operation it had rise and returned to the Home of the Red Cross. It is the most impressive thing that went out from the room of the hospital and that drove the wheelchair even to the exit. Another good piece of news was giving to me now: the protocol had been celebrated in order that the physiotherapist used the installations of Red Cross Military Home to effectuate the physical recuperation of cases similar to that of my friend Isidro.

                      I have been accompanying some of his sessions by recuperation and by day for day it is showing obvious signs of which the distance will be for better: it already lifts lightly the trunk for his effort itself, it withdrew the catheter and it does his basic necessities with the own sensations of these human acts.

                      Another case what I could check with my eyes was it of Patxi, a Basque boy, victim of a disaster of motorbike, what did the operation there are 3 months and it came up to Lisbon for more a few sessions of physiotherapy with Graça Mendes, now manage to sway already on top of the bed, to be put of knees, play a ball with the feet and his trunk he already presents a normal posture. His nearest friend, companion in the opportunity, was amazed by his evolution.

                      I was calling myself to see the effort of Patxi, "es estrondoso, maravilhoso, hace 3 meses no se movia, nada, nada, nada. Ahora joga a pela" ("it is loud, marvellous, there are 3 months behind it was not moving down of the waist, swim, swim, it swims. Now it kicks the ball".

                      I keep on seeing wonders every day in those hands of the physiotherapist Graça, modelling efforts for the recuperation of my friend. I think myself lucky the meeting with the doctor, Doctor Reis, for the sympathy, dedication and courage for breaking the barriers of the knowledge. I believe more and more in the project Step by Step that it gives hope and opportunities to the one who has not them or it lost them that there has much in the life. "The hope is the last one to die", say the portuguese people and with the reason of centuries of culture, like today it has never any more present.

                      I wait that one day, Portugal gives the recognized merit and value to this man of the science and of the medicine and the opportunity for seeing being born a centre of competences, formation and innovation in this matter of the neurosurgery.

                      Today I feel very little and humbler. I wish all of you what never lose the hope, since the way ahead is hard and full of difficulties. It has in me a companion of journey for the difficulties, a partner, the help and the
                      incentive in the distance.

                      Well have for your attention. Thank you.

                      In tribute of how many like you do they give a kick in the (im)possible one and do not give up.

                      José Antunes
                      ideas2win
                      ideas2win@gmail.com
                      Last edited by willbryner; 11-03-2006, 09:34 PM. Reason: mistake

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                      • #12
                        Tank´s for all Jose...

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                        • #13
                          I don't understand!!!
                          Every buddy is crazy about stem cells implant and any one stink about this.
                          I stink this is the frist step to a cure for chronic spinal cord injury.
                          Am I crazy?

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                          • #14
                            This sounds like a promising approach to eliminate problems such as syringomyelia. However, how does it differ from the detethering procedure favoured by Green of Miami and Falci of Denver - isn't this already established as preferential treatment?

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                            • #15
                              Hello Terence

                              No, this is different.
                              Reis remove all the arachnoid at the level of the scar and removes the altered arachnoid at two or more levels above and below the lesion.
                              I sink, Green and Falci removes partially the arachnoid and they use shunts and stents to drain the cysts.
                              This is new, and the most neurosurge can use this approach to gives a good recovery to all pacients whid cronic sci. The results are amaizyng!
                              Last edited by Nina-1964; 11-09-2006, 05:26 PM.

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