Finally, progress for paraplegic patients

Paraplegia, the impairment of the motor or sensory function of the lower body due a problem with the spinal cord, has been recognised as a medical issue since ancient Egyptian times in the Edwin Smith Surgical Papyrus medical text. This was accompanied with a warning that it was “an ailment not to be treated”. As recently as 2003, the orthopaedic surgeon John Russell Silver declared that the “spinal cord cannot be repaired”.

Until 2012, paraplegia remained firmly in the league of the incurable; it had been discussed extensively, with a range of measures to improve the process of living with the condition, but remained, from most angles, a death knell for a physically active life.

“Dr Raisman somewhat lyrically relates a damaged spinal cord to a road interrupted by ploughed fields and mountains”

Last month, the New Yorker published the article “One Small Step”, regarding 41-year-old Darek Fidyka, a Polish contractor and volunteer fireman, who became paralysed from the waist-down following a stabbing that almost completely severed his spinal cord.

Much like paraplegic patients worldwide, Fidyka was told that walking again would not be possible. His treatment focused on alleviating the medical problems that accompanied his paralysis, such as lung infections, inflammation in leg veins and pressure sores, and a physical therapy regime that yielded no significant results.

In six months, Fidyka had exhausted his medical benefits. Hope was slipping.

Fate intervened when his cousin came across an article on the ongoing work of Dr. Geoff Raisman, Chair of Neural Regeneration at the University College London Institute of Neurology, and Dr. Pawel Tabakow, a consultant neurosurgeon at the Wroclaw Medical University in Poland, and suggested Fidyka ask to become a patient.

Doctors Raisman and Tabakow were in the early stages of developing a means of spinal repair involving the injection of specialist cells from the nasal lining, called olfactory ensheathing cells, which allow the nerve cells that provide us our sense of smell to recover when damaged, into the injured spinal cord.

“Until 2012, paraplegia remained firmly in the league of the incurable”

Likening the spinal cord to a roadway and its nerve fibres to a car, Dr Raisman somewhat lyrically relates a damaged spinal cord to a road interrupted by ploughed fields and mountains. The introduction of regenerative olfactory nerve cells into the vertebra may re-link the damaged spinal cord and re-establish the communication of nerve fibres.

When Fidyka first met Dr. Tabakow, this approach had yet to be tested beyond rats, and it would have been years before the procedure was approved for human application.

In a stroke of perverse luck, however, the declining usability of Fidyka’s olfactory ensheathing cells as a result of a prior sinusitis operation lent a degree of urgency that prompted an unprecedented approval from the Wroclaw University Hospital’s ethics board.

Following eight months of a 40-hour weekly physical therapy regime and electrical stimulation of the vertebra to rule out the possibility of a spontaneous recovery, Fidyka underwent the first leg of the procedure. This involved the removal of his olfactory bulb by opening his skull, before slicing the extracting tissue to isolate his olfactory ensheathing cells.

To obtain a sufficient number of ensheathing cells (totalling a grand half a million) for the second leg of procedure, the cells were given two weeks to subdivide. Fidyka’s spine was then opened up. Over a hundred microinjections were made, situating the ensheathing cells around his wound and onto a band of nerve tissue that was extracted from his lower leg before being inserted into the spinal column.

The operation was a success.

Today, Fidyka is the first person in history to recover from an almost complete severing of the spinal cord. A measure of normalcy has returned to his life; Fidyka is able to stand on his feet, drive a car, pedal a stationery bike and walk continuously for an hour and a half.

As research continues, the bleakness that underscores severe spinal injuries seems to be, finally, waning.

Spinal cord

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