Use of the Case Western Reserve/Veterans Administration neuroprosthesis for exercise, standing and transfers by a paraplegic subject.

Functional electric stimulation (FES) is a technology that may allow patients with spinal cord injury (SCI) to transfer stand and walk. This paper reports upon the use of the Case Western Reserve Neuroprosthesis by a T6 ASIA B paraplegic subject. The subject was able to stand for two minutes and 50 seconds. He could walk 35 feet with a swing to gait. Measurement of energy consumption showed that metabolic demand was only 2.1 metabolic equivalent units. The factors that limited the use of the device that need to be improved to make the technology practical for household or community ambulation are speed (5.8 m/min) of ambulation and fatigue of the stimulated muscles.

Multilevel anterior cervical fusion using a collagen-hydroxyapatite matrix with iliac crest bone marrow aspirate: an 18-month follow-up study.

OBJECTIVE: The pseudarthrosis rate after multisegment anterior cervical fusion is directly related to the number of levels surgically fused. The advent of osteobiological adjuvants offers an opportunity to reduce both the likelihood of failed arthrodesis and the need for posterior instrumentation. Collagen-hydroxyapatite matrix is osteoconductive and has been used with autogenous bone marrow aspirate (BMA) to promote fusion. We report our results of using collagen-hydroxyapatite matrix with BMA for multilevel anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion (ACCF). METHODS: Sixty-six consecutively treated patients underwent a multilevel anterior cervical discectomy and fusion and/or ACCF during a period of 16 months. In all cases, a Smith-Robinson decompression was performed followed by allograft fibula strut grafting filled with collagen-hydroxyapatite matrix and BMA, and anterior semiconstrained cervical plating. A vacuum chamber was used to draw the BMA slowly through the collagen-hydroxyapatite sponges. No patient underwent simultaneous posterior instrumentation. Clinical outcome was determined by an independent observer who evaluated patients on the basis of symptom and neurological examination results. Radiographic fusion was determined by dynamic x-rays and computed tomographic scanning during an 18-month follow-up period. RESULTS: With the inclusion of discectomies performed in ACCF procedures, patients were fused between two and five disc levels (mean, 3.1 levels). Seventeen patients underwent one to four-level corpectomies (mean, two levels). Clinical improvement was observed in 49 patients. Conditions in nine patients remained unchanged, and two patients had radicular palsies. In all, 60 patients were followed and analyzed for radiographic fusion. All but two patients demonstrated successful radiographic fusion. CONCLUSION: Collagen-hydroxyapatite matrix with BMA can be a safe, effective adjuvant for promoting fusion in multilevel anterior cervical discectomy and fusion and ACCF. Although randomized, controlled studies are necessary to determine whether or not the fusion rates are superior to those obtained from using allograft alone, these results compare favorably to historical data in the literature.

Energy cost of the case Western reserve standing neuroprosthesis.

OBJECTIVE: To determine the oxygen consumption of a person with C7 American Spinal Injury Association (ASIA) grade B tetraplegia using the Case Western Reserve/Veterans Administration (CWRU/VA) standing neuroprosthesis. DESIGN: Measure the oxygen consumption and carbon dioxide production of a person with C7 ASIA grade B tetraplegia at rest, standing in the parallel bars with the CWRU/VA system on, ambulating in the parallel bars, and transferring from a wheelchair to a mat with the system on. SETTING: University medical center. PARTICIPANT: A 26-year-old man with C7 ASIA grade B tetraplegia. The subject was a recipient of the CWRU/VA standing neuroprosthesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurement of oxygen consumption and carbon dioxide production using a metabolic cart. RESULTS: Oxygen consumption of the subject was 1.22mL.kg(-1).min(-1) at rest. It was 4.7mL.kg(-1).min(-1) while standing in the parallel bars, 7.2mL.kg(-1).min(-1) while ambulating in the parallel bars, and 7.9mL.kg(-1).min(-1) when transferring from a wheelchair to a mat. CONCLUSIONS: Oxygen consumption of the subject when using the system is about 2 metabolic equivalent units, which is compatible with sustained use of the system for standing.