Partial restoration of spinal cord neural continuity via vascular pedicle hemisected spinal cord transplantation using spinal cord fusion technique

Abstract

Aims:Our team tested spinal cord fusion (SCF) using the neuroprotective agent polyethylene glycol (PEG) in different animal (mice, rats, and beagles) models with complete spinal cord transection. To further explore the application of SCF for the treatment of paraplegic patients, we developed a new clinical procedure for SCF called vascular pedicle hemisected spinal cord transplantation (vSCT) and tested this procedure in eight paraplegic participants.Methods: Eight paraplegic participants (American Spinal Injury Association, ASIA: A) were enrolled and treated with vSCT (PEG was applied to the sites of spinal cord transplantation). Pre-and postoperative pain intensities, neurologic assessments, electrophysiologic monitoring, and neuroimaging examinations were recorded.Results: Of the eight paraplegic participants who completed vSCT, objective improvements occurred in motor function for one participant, in electrophysiologic motor-evoked potentials for another participant, in re-establishment of white matter continuity in three participants, in autonomic nerve function in seven participants, and in symptoms of cord central pain for seven participants. Conclusions:The postoperative recovery of paraplegic participants demonstrated the clinical feasibility and efficacy of vSCT in re-establishing the continuity of spinal nerve

Stem Cell Strategies in Promoting Neuronal Regeneration after Spinal Cord Injury: A Systematic Review

“…The most promising results are observed around peripheral nerve repair, where it seems to be able to continuously repair solutions at the level of the axonal membrane [ 109 , 110 ]. Among the different fusogens, the most used and promising seems to be polyethylene glycol (PEG), used in experiments for the repair of both peripheral nerves and in cases of spinal cord damage [ 107 , 111 ]. The direct application of PEG to the site of spinal cord damage can repair cell membranes, mitigate oxidative stress and the formation of the glial scar, and promote axonal regeneration, managing to restore motor function [ 112 ].…”

Application of“Spinal cord fusion” in spinal cord injury repair and its neurological mechanism

“…To date, 20 patients with paraplegic SCI have been recruited and treated with SCF surgery and no complications have been reported in the perioperative period. Preliminary results indicate that SCF can restore the morphological continuity of the spinal cord [ 57 , 58 ] ( Fig. 2 (A and B)).…”

“…④. PEG is locally applied at the end of the joined spinal cord stumps. Vascular pedicle hemisected spinal cord transplantation [ 57 ]: specifically designed for patients with chronic SCI with injury located in the thoracic segment, featuring only mild atrophy of the distal spinal cord. Based on a previous animal study [ 59 ], our team developed a novel procedure involving the resection of the spinal cord lesion and rotation of a short vascularized hemisection from one of the adjacent spinal cord stumps.…”

“…D. Then half of the spinal cord tissue was transplanted into the spinal cord defect area. E. PEG was topically applied to the two sites of spinal cord transection created after the transplantation to complete the SCF [ 57 ]. Sural nerve transplantation [ 58 ]: applied to patients with chronic SCI with injury areas close to the spinal cord and cauda equina or severe spinal atrophy at the distal end of the injured area.…”

“…B. Three months postoperatively, T2W showed spinal cord reconnection and DTI showed morphological continuity of axons at the two transected spinal cord ends [ 57 ].

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