Walking and Running Again After Spinal Cord Injury

[ScienceRocks]

Walking and Running Again After Spinal Cord Injury

ScienceDaily (May 31, 2012) — Rats with spinal cord injuries and severe paralysis are now walking (and running) thanks to researchers at EPFL. Published in the June 1, 2012 issue of Science, the results show that a severed section of the spinal cord can make a comeback when its own innate intelligence and regenerative capacity is awakened. The study, begun five years ago at the University of Zurich, points to a profound change in our understanding of the central nervous system. According to lead author Grégoire Courtine, it is yet unclear if similar rehabilitation techniques could work for humans, but the observed nerve growth hints at new methods for treating paralysis.



"After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles when stimulated," explains Courtine, who holds the International Paraplegic Foundation (IRP) Chair in Spinal Cord Repair at EPFL.
Waking up the spinal cord
It is well known that the brain and spinal cord can adapt and recover from moderate injury, a quality known as neuroplasticity. But until now the spinal cord expressed so little plasticity after severe injury that recovery was impossible. Courtine's research proves that, under certain conditions, plasticity and recovery can take place in these severe cases -- but only if the dormant spinal column is first woken up.
To do this, Courtine and his team injected a chemical solution of monoamine agonists into the rats. These chemicals trigger cell responses by binding to specific dopamine, adrenaline, and serotonin receptors located on the spinal neurons. This cocktail replaces neurotransmitters released by brainstem pathways in healthy subjects and acts to excite neurons and ready them to coordinate lower body movement when the time is right.
Five to 10 minutes after the injection, the scientists electrically stimulated the spinal cord with electrodes implanted in the outermost layer of the spinal canal, called the epidural space. "This localized epidural stimulation sends continuous electrical signals through nerve fibers to the chemically excited neurons that control leg movement. All that is left was to initiate that movement," explains Rubia van den Brand, contributing author to the study.

Walking and running again after spinal cord injury

 

[waltky]

Granny gonna sign Uncle Ferd up for it so she don't have to shovel snow no more...

Minimally invasive surgery shortens recovery periods
Mon, Feb 10, 2014 - MINIMUM FUSS: Patients undergoing the surgery to fix slipped discs can often walk normally a short time after the procedure and be discharged on the same day

A man who stayed up all night playing mahjong during the Lunar New Year holiday suddenly felt pain below his waist and numbness in his right thigh and shin, and was later diagnosed with a spinal disc herniation, commonly known as a slipped disc. Chen Chien-min, the director of the neurosurgery division at the Changhua Christian Hospital, said the patient had a herniated disc between the fourth and fifth lumbar vertebrae in the lower back, which caused a bulge that put pressure on the patient’s right root nerve.

The hospital performed a minimally invasive spinal surgery (MISS) on the patient, with the patient able to walk later on the day of the surgery and being discharged the next day, Chen said. The neurosurgeon said the surgery involved using an endoscope — a very thin fiber-optic video camera — and specialized retractors to perform the surgical procedure through tiny incisions in the patient’s lower back. Watching the video screen showing images sent by the camera placed inside the body, the protrusion, or the portion of the disc that was pushing against the nerve root, was removed.

Chen said that MISS, with its tiny incisions, avoids potential significant damage to the spine and some patients, following proper evaluation, can even have the microdiscectomy done under local anesthesia. Most of the patients undergoing the surgery can have a very short hospital stay, being discharged on the same day as the surgery or the day after, he added. Chen said that a healthy spine can be maintained by avoiding staying in the same position for a long period of time and if a person has to sit for long periods, by placing a cushion behind the lower back to maintain the spine’s natural curve and allow the spine to relax.

Minimally invasive surgery shortens recovery periods - Taipei Times

 

[waltky]

Have a friend who suffers from this...

New Surgical Techniques Help Relieve Pain from Spinal Injury
October 28, 2016 — Being in a wheelchair has never slowed Jon Forbes down. But for 14 years after his spinal cord injury, Forbes says something else nearly broke his will to live. It was pain - electric shocks of pain - in areas of his body that were paralyzed. “It was horrible. Excruciating. And it never stopped," he recalled. "You wake up, it’s there. All day, it’s there. You go to bed, it’s there.”

According to the World Health Organization, roughly 25 million people around the world live with a spinal cord injury. The injuries are well-known for causing paralysis and difficulty with using legs and hands. Less recognized is the common side effect Forbes described -- neuropathic pain, which creates feelings of electric shocks and stabs in parts of the body that no longer have regular sensation. In roughly 10 percent of cases, this neuropathic pain can be so relentless, victims consider suicide. Forbes did. “I had tried pretty much every kind of drug, tried exercise, tried you name it. Anything and everything to try and get this pain to stop. And it wouldn’t. And I was working at an investment bank and decided this was it." He starts to tear up as he remembers that time of his life. "Quit my job, and decided, this was going to be the end. I just couldn’t take it.” But then, he learned about a Denver neurosurgeon who uses spinal surgery to stop so-called “suicidal pain.”

The last resort

Scott Falci acknowledges, “Patients, when they ultimately come to me, I’m kind of a last resort.” As the chief neurosurgical consultant at Denver’s Craig Hospital, which specializes in spinal cord injury rehabilitation, Falci has helped hundreds of paralyzed patients who suffer excruciating neuropathic pain. “You could cut them with a knife, they wouldn’t feel it. You could put a blow torch on their foot. I’m being extreme here. They wouldn’t feel it," he stresses. "Yet they’ll tell me, 'my foot is on fire, as if someone has set it on fire.' 'Battery acid’s on my foot', and they can be very site specific. They’ll say, 'I have electricity running from my hip to my knee,' or 'the bottom of my foot, it’s on fire.' 'At the ankles it’s somebody stabbing me with a knife.' They feel the pain precisely in very specific areas, but if you were to touch them on those areas, they couldn’t tell you.” For spinal cord patients, conventional pain therapies frequently fail, so often doctors suggest the pain is “in their head.” But, Falci says, it's actually in their spinal cord. He resolves it with surgery.

Revolution in the OR

Under lamps as bright as the sun, half a dozen surgical assistants help Falci for hours, just to reveal the spinal cord. He explains, "You have to open up the skin, the muscles, you have to get to the skeleton, and you have to remove some bone in the back of the skeleton to even get to see the spinal cord." Finally, the spinal cord is revealed, glistening, white, alive. Falci seeks out pearl-colored “root entry zones,” each the size of a small button, filled with thousands of cells. These are where nerve bundles bring sensations from the body and root into the spinal cord. “These nerve cells that come from different parts of the body don’t travel all the way up to the brain," he notes. "They connect first with other nerve cells in the spinal cord and let them communicate signals to the brain.” Using a pin-sized electrode, Falci carefully probes two millimeters into these areas, to touch relay nerves in the spinal cord that speed sensory information toward the brain. Mostly he gets a calm electric signal. Then, there’s a spike, the sign of hyperactive nerve cells. Falci calls them "hot spots" -- seizure-like areas of the nerve cells firing with high energy when they shouldn’t be firing.

He says hot spots can trigger suicidal pain. “So you can imagine, the hyperactive areas of the spinal cord, almost every second of their life, bombarding their brain and telling them they’re with pain.” Using heat, Falci kills each hot spot. There can be hundreds, so meticulously, he moves up the spinal column, killing hot spots. He also does something that neurosurgeons have considered out of the question. “We didn’t believe the spinal cord below the level of injury could possibly send signals to the brain," he explains, but even if an injury has completely cut the spinal cord in half, Falci finds and kills hot spots below the injury. He explains that nerve signals coming in from the body can detour around a spinal cord injury. He likens this to how highway drivers detour onto local lanes to avoid an accident, then after the accident, they merge back on the highway. When it’s hyperactive nerve signals creating a detour in the body, Falci says they carry false pain signals. So by killing hot spots below the injury, he eliminates more pain. “Eight-five percent of the time, we can get rid of sharps, burns, electricals, stabs.”

New lease on life

Falci says this can be life changing. It was for Jon Forbes, who got this surgery two years ago, and reports, “I’m a pretty happy person these days.” Just two months after the operation, Forbes landed a new job — as the deputy treasurer for the state of Colorado. “I’m not 100% without pain," he admits, "but I can live, and I want to live, which is . . . thank God for saving my life, Dr. Falci.” Falci plans to publish new research that maps this “detouring” nervous system. His work makes him confident that there’s more to discover about how the human body deals with injury and pain.

New Surgical Techniques Help Relieve Pain from Spinal Injury