Spinal cord bypass surgery using peripheral nerve transfers: review of translational studies and a case report on its use following complete spinal cord injury in a human. Experimental article.

Spinal cord injury has been studied in a variety of in vitro and in vivo animal models. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into the spinal cord below the level of injury. A model of spinal cord injury in rodents has shown the growth of peripheral nerve fibers into the spinal cord, with the subsequent development of functional synaptic connections and limb movement. The authors of this paper are currently developing a similar model in felines to assess the cortical control of these novel repair pathways. In an effort to determine whether these neurotization techniques could translate to spinal cord injury in humans, the authors treated a patient by using intercostal nerve transfer following complete acute spinal cord injury. The case presented details a patient with paraplegia who regained partial motor and sensory activity following the transfer of intercostal nerves, originating above the level of the spinal cord injury, into the spinal canal below the level of injury. The patient recovered some of his motor and sensory function. Notably, his recovered hip flexion showed respiratory variation. This finding raises the possibility that intercostal nerve transfers may augment neurological recovery after complete spinal cord injury.

Nonvascular complications following spinal manipulation.

BACKGROUND CONTEXT: Spinal manipulation is associated with various vascular and nonvascular complications. Most prior studies have focused on the vascular complications. PURPOSE: The purpose of this study is to better clarify the spectrum of nonvascular complications following spinal manipulation, and to help define the risks of manipulative treatment. STUDY DESIGN: Review of medical records and radiographic studies of appropriate subjects. PATIENT SAMPLE: Patients presenting to a neurosurgical practice over a 6-year period who suffered a qualitative worsening of symptoms immediately after spinal manipulative treatment. OUTCOME MEASURES: Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery. METHODS: Record review of 18 patients. RESULTS: Eighteen patients were identified who had received spinal manipulation and whose neurological condition immediately worsened. Injuries were sustained to the cervical, thoracic, and lumbar spine and resulted, variously, in myelopathy, paraparesis, cauda equina syndrome, and radiculopathy. Eighty-nine percent required surgery. Outcome was excellent in 50% and good in 37.5%. Three patients died from unrecognized malignancies. CONCLUSION: Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop.