Posts from ‘Latest Research’
Spinal cord injury patients around the world may draw new hope for the future from the story of a paralyzed little dog who was able to walk again after receiving an experimental spinal cord treatment. Cambridge University scientists pioneered the new treatment that made it possible for Henry the dachshund to walk after he was paralyzed by a severe spinal cord injury.
Veterinarians at the Cambridge Veterinary School took cells from the dog’s nose and injected them into his ailing spinal cord. The New York Daily News reported that nose cells were used because they encourage the growth of new nerve fibers in the spinal cord. Henry had lost the ability to walk at the end of last year when discs between the vertebrae in his spine ruptured. It was also reported that certain species of canines have an increased risk of spinal cord injuries, so they make good candidates for exploration of experimental treatments.
Scientists had previously reported success with the nose cell technique in experiments with rats, which inspire professors Nick Jeffrey and Robin Franklin to attempt the experimental procedure on the dachshund. The scientists hope to eventually use the procedure to treat human patients with severe spinal cord injuries.
In addition to the medical treatment, Henry received physiotherapy and rehabilitation on a treadmill. Only a month after getting the nose cell treatment, Henry was able to walk again. The poor little puppy was reportedly downtrodden and depressed before he received the procedure. Afterward, his owner reported signs of the dog’s returning happiness.
Sarah Beech, the owner of the lucky dachshund, was amazed by the miraculous results of the veterinary treatment. She was quoted in the New York Daily News article saying, “It’s incredible,” Henry’s owner, Sarah Beech, told the Daily Mail. “I didn’t think Henry would ever be able to walk again, but over the last few months, he has been wagging his tail and taking small steps.”
The news of such rapid success in reversing Henry’s paralysis should bring hopeful expectation to the many spinal cord injury patients waiting for such amazing treatments to be made available to humans. With all the recent advances in spinal cord injury treatments, it seems only a matter of time before paralysis is seen as a temporary, instead of irreversible, condition.
(pic from flickr.com/photos/franklin_hunting)
Manufacturers of dynamic spine stabilization systems may be sent back to the proverbial drawing board to improve their devices after a recent Food and Drug Administration (FDA) injunction ordered them to conduct new studies to insure the safety of their products. The FDA ordered the manufacturers to conduct post-market surveillance studies to monitor fusion rates and other possible safety issues related to the stabilization products. The FDA order also requires manufacturers to gather pre-market clinical data on not-yet-released products. The order may result in labeling changes on future devices.
The FDA’s concern arose due to a lack of substantial clinical data to show how well the devices in question provide support for complete spinal fusions. Their concern is that there is not enough data to conclusively demonstrate that the devices are strong enough. The FDA worries that the dynamic stabilization systems may loosen, break, or bend under pressure over time. If the devices do happen to be faulty, spinal injury patients would be at great risk of suffering additional injuries and may require further surgical procedures. The FDA order does not affect the methods by which the stabilization devices are employed.
Older conventional spinal stabilization systems consist of screws and metal rods anchored into the spine during bone fusion spinal surgeries. Dynamic systems are different. They employ flexible polymer cords, springs, and movable screw heads to allow patients the freedom to bend and rotate their spine, which the conventional systems do not.
The FDA order insists that post-market studies investigate: the rate of fusion in the dynamic systems compared to traditional rigid systems; details, rates, and severity of any side effects, also compared to rigid systems; additional surgeries and types of surgeries required for dynamic systems vs. the rigid models; and finally, any and all causes of failure of any systems leading to a surgical removal of the devices from patients’ spines.
Since bone fusion devices are classified as class II devices in FDA labeling regulations, newer-model devices are allowed to be developed and manufactured if they are demonstrated to be substantially equivalent to predecessor devices already approved on the market.
Dynamic stabilization systems first received approval from the FDA in 1997, and they will likely continue to be used in the future. The FDA mandate promises to improve the effectiveness and safety of such devices.
(pic from drsharma.ca)
A double-blind study release on August 5, 2009 in the New England Journal of Medicine showed that vertebroplasty a procedure that involves the injection of medical cement into the spines of patients who have spinal fractures proved only equally effective as simulated vertebroplasty with no spinal cement injection. One group of patients received the actual vertebroplasty procedure, and the control group received a mock procedure including everything but the cement injections into their spines.
The study’s leader, Dr. David Kallmes, said that while vertebroplasty has been long accepted and utilized as a treatment option for many years, there has been no data or research to verify its effectiveness. The findings of the study conducted by a team of researchers at the Mayo Clinic in Rochester, MN showed that relief of pain and improvement in dysfunctions related to the pain proceeded similarly in both the group of patients who received the vertebroplasty and the control group who did not. The progress of the patients involved in the study will continue to be monitored over the course of one year, after which the comprehensive results of the study will be published.
The study was partially motivated by doctors’ concerns that the cement injections into patients’ spines could potentially increase the risk of future spinal cord injuries. Dr. Kallmes was careful to add that vertebroplasty does actually work. However, scientists and doctors may be able to achieve similar results without the potentially dangerous cement injections.
Kallmes was quoted in a EurekAlert article speculating that the improvements recorded in the control group could be the result of, “…local anesthesia, sedation, patient expectations, or other factors.” He also advised patients to seek professional advice before deciding on treatment options. Many other studies related to treatment for spinal fractures are currently underway at the Mayo Clinic. They will be reported on as the studies and their findings are published.
Many other institutions were involved in the vertebroplasty study, including: the University of Washington, Seattle; Nuffield Orthopaedic Centre NHS Trust, Oxford, UK; St. George Hospital, University of New South Wales, Sydney, Australia; Gartnavel General Hospital, Glasgow, UK; Department of Social Medicine, Bristol, UK; Nottingham University Hospital NHS Trust, UK; and Western General Hospital, University of Edinburgh, UK.
The huge amount of global attention dedicated to improving conditions for spinal cord injury patients is encouraging. Their dedication is producing constant improvements in the quality of care and effectiveness of treatments around the world.
(pic from spineuniverse)
Janneke J. P. Schimmel, MSc, a scientist at Sint Maartenskliniek in Nijmegen, The Netherlands, recently spoke about the findings of a study on the occurrence of infections in lumbar fusion surgery sites. The study performed by Schimmel and a team of Dutch researchers showed that there is a link between lumbar spinal fusion surgery and surgical site infections on surgeries done in the same location.
Orthopedics Today quoted Schimmel who said, “Our main finding is that previous surgery was associated with the higher risk for the appearance of an infection. More complex surgery resulted in an increase for the infection rates.” She also noted that the longer it took to perform a spinal surgery, the higher the chance of infection at the surgery site. Schimmel reported on the findings of the 9-year-long study in Miami, Florida at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine.
The investigators gathered and analyzed data on more than 1400 patients who had received lumbar fusion surgery in The Netherlands between 1999 and 2007. The study identified many factors concurrent with the appearance of deep infections at the site of the operations. In addition to factors already mentioned, patients who smoke cigarettes, and patients with diabetes mellitus were also found to be at greater risk of deep infections after lumbar spinal fusion surgery. The data for the study was collected from hospital databases and patient charts.
The intensive study showed that out of 1454 patients, 31 of them tested positive for bacterial infections. Nearly all of the infections found were caused by Staphylococcus basteria.
The increased costs of treatment for postoperative infections are staggering. Over 1000 extra hospital days were required for further treatment of patients with deep infections in their spines. The Orthopedics Today article reported that it is extremely costly to treat and care for deep infections due to longer hospital stays and expensive pharmaceuticals, lab tests, and other necessary procedures.
Some implications of the study suggest that shortening the length of time it takes to perform lumbar fusion surgery could lessen the chance of infection. This may inspire innovative surgeons and researchers to develop faster, more efficient, and less invasive procedures for lumbar surgery in the future.
(pic from flickr.com/photos/doctorow)
Spinal Cord injury and spinal cord dysfunction patients have new cause to celebrate. Last week marked the official launch of the Academy of Spinal Cord Injury Professionals. With support form the Paralyzed Veterans of America, the new interdisciplinary academy aims at improving the quality of care and quality of life for spinal cord injury patients.
Nurses, doctors, social workers, rehabilitation therapists, and psychologists will be able to work together more closely as part of the new academy to share data and pool their knowledge and experience to work toward developing more effective treatment plans and improving the quality of life-long care for those suffering with spinal cord injuries.
The Academy of Spinal Cord Injury Professionals arose as a merger between the American Association of Spinal Cord Injury Nurses, the American Paraplegia Society, the American Association of Spinal Cord Injury Psychologists and Social Workers, and the Therapy Leadership Council in Spinal Cord Injury.
The professionals who make up the academy hope to achieve their goals by way of: raising public, lawmaker, and charitable organization awareness of the challenges of life with spinal cord injury; encouraging community development in support of spinal cord injury patients; and providing advanced networking opportunities for spinal cord injury professionals.
As in many areas of science, an interdisciplinary collaboration can result in revelations and rapid advances in applicable knowledge due to the sharing of experience and information facilitated by such partnerships. For example, a spinal cord injury psychologist may be able to assist as a liaison between patient and family and between patient and doctor, making communication and understanding more easily achieved for all parties involved.
The Academy of Spinal Cord Injury Professionals uses “Many Minds, One Vision,” as their tagline. The vision statement on their site reads, “The Academy of Spinal Cord Injury Professionals aims to be the world’s premier, interdisciplinary organization dedicated to advancing the care of people with spinal cord injury/dysfunction. We have one vision: it is a world where people with disabilities are healthier, more independent, and more empowered through a comprehensive lifetime of care and full community participation to take on all the challenges that life presents.”
The Ohio State Medical Center (OSMC) recently published a study online in the Journal of Clinical Investigation. The study explored the effects of the body’s immune response after a spinal cord injury. It was already widely known that immune cells gather and release large amounts of antibodies in spinal fluid around a fresh injury site. Up until the OSMC study was published, no one knew exactly how those antibodies affected the injury. The study revealed that antibodies can actually damage and worsen the spinal cord injury by confusing the immune system into attacking the cells near the injury site as a response.
The study leader, Phillip G. Popovich, discerned a possible solution to the problem they identified. By inhibiting certain antibody-producing cells, the scientists asserted, a spinal cord injury patient might benefit from faster healing and reduced risk of more severe long-term damage. Popovich said, “[The antibodies] may also help explain why the central nervous system does not repair itself efficiently and why other impairments often follow spinal cord injury.”
The study was conducted using anaesthetized mice that had been given moderate spinal injuries. Half of the mice had normal immune systems and the other half had immune systems that did not produce antibodies. The group with the inhibited immune systems showed about 30% smaller areas of injury than the mice with normal functioning immune systems.
To determine whether or not it the accumulation of antibodies around the spinal cord injury site was to blame for the larger and more severe injuries, the researchers injected antibodies from injured mice into the spinal cords of healthy mice. They became partially paralyzed and showed signs of damage to their spinal cords only 48 hours after the injections.
Another researcher in the study, Daniel P. Ankeny, said, “These experiments essentially prove that the antibodies have the potential by themselves to make spinal lesions worse.” The researchers also suggested that other health issues that arise in concert with spinal cord injuries might be related to and even caused by the heightened presence of antibodies in the bloodstream. Further research may reveal a host of problems associated with the antibodies in the system.
Better treatments designed to slow down the body’s immune response to spinal cord injuries may result from the findings of this study and further research to determine whether or not the results translate into human patients.
(pic from flickr.com/photos/tudor)
A team of scientists from the University of California San Diego (UCSD), UCLA and the San Diego Veterans Affairs Medical Center reported in the journal Nature Neuroscience that they had partial success in restoring damaged nerve connections in lab rats. This was based on earlier research in which scientists discovered a method to regenerate axons.
Axons are the fibers that connect neurons and carry signals between them, allowing communication between the brain and the nervous system. Axons are damaged or destroyed in spinal cord injuries, causing communication between neurons to be interrupted, which can mean sensory loss and paralysis.
Scientists used a three-part therapy in their study. First, they injected a harmless virus with a chemical growth hormone into the injury site. The growth hormone draws growing axons to the site. Next, they placed a cell graft across the injury site to encourage the young axons to grow. Finally, they stimulated genes in the injured neurons to amplify axon growth.
While the therapy practiced by the team is far from perfect, and will require much more study before being tested on humans, it offers hope to the more than 5.6 million Americans suffering some form of paralysis, 23% of them due to a spinal cord injury.
The team’s success was only partial because, although the axons found their way to the precise spinal injury site and formed connections with other nerve cells, the new neural connections did not have a myelin sheath. The myelin sheath is a fatty sheath that acts as a sort of electrical insulator to assist in the passing of electrical signals between the brain and the body’s nervous system. Since the new connections lacked a myelin sheath, they proved effectively inactive.
Further research is being planned by the same team of scientists to add another step to the already complex therapeutic process in which they hope to encourage the formation of myelin sheaths at the injury site. Although the translation from rats to humans may prove difficult, the creation of the myelin sheath will bring scientists one step closer to fully repairing nerve damage and potentially reversing paralysis.
In Menlo Park, California, the biotech company Geron has plans underway to conduct clinical studies on humans with spinal cord injuries. They will inject embryonic stem cells into spinal cord injury patients in the hopes that the cells will form oligodendrocytes, which in turn assist in the formation of myelin sheaths.
This combination of research inches ever closer to the possibility of full spinal regeneration after a severe injury. While it is nowhere near perfect yet, the promising research continues.
Researchers from the University of Rochester in Rochester, New York have discovered that injecting large amounts of the food dye Blue Dye No. 1 into rats shortly after spinal injuries reduces the chances for paralysis and other spinal injury complications. There is a catch, however; the injection of the dye made the rats turn blue.
This research was developed on earlier studies by the same team, which demonstrated that ATP, the body’s cellular energy molecules, floods into the injured area in the spinal column. The high concentration of ATP destroys healthy motor neuron cells and increases the severity of the injury.
First, the team of scientists attempted to use oxidized ATP to block the effects of ATP. It showed positive results, but at the risk of dangerous side effects. The team then found that an injection of blue food dye had similar results without the side effects of oxidized ATP.
The amount of blue dye needed to achieve the desired therapeutic effects is far greater than the amounts consumed in food, so don’t expect an immediate application. There is still a lot to be done before blue dye can be tested and approved for human use in treating traumatic spinal cord injuries.
Doctors from the University of Washington in Seattle recently reviewed recovery and follow up data on 342 patients treated for spinal cord injury with halo vest immobilization (HVI). They found that although complications were relatively high, as many as 35 percent of patients experienced difficulties such as pneumonia with the HVI, the treatment proved effective in up to 85 percent of cases.
The complications arose due to pin site infections and instability issues. The doctors also found that the use of HVI in cervical spine injuries can replace the need for surgery in many cases.
The medical team who reviewed the cases concluded that the use of the HVI to treat spinal injuries remains highly effective, in spite of the challenges presented to both patients and their caregivers.
Halo vests, also called halo rings or halo crowns, are used to stabilize the cervical spine following fracture or dislocation of the spine.
Image from here.
