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Laurance Johnston, Ph.D.

Sponsor: Institute of Spinal Cord Injury, Iceland



1) Heinrich Cheng (Taiwan)

2) Dr. Shaocheng Zhang (China)

3) Dr. Carl Kao (Ecuador)

1) Dr. Heinrich Cheng: In 1996, Dr. Cheng and colleagues (Stockholm, Sweden) published a widely cited article on functional regeneration in rat spinal cords after peripheral nerve implantation (Science 273, 1996). Building upon this work, he has since transplanted peripheral nerve segments and injected a mixture of growth factors into the injury site of many patients with both acute and chronic SCI. There is considerable interest in SCI in Taiwan because the country’s “first lady” sustained a SCI.

Recently, Cheng and colleagues (Tapei, Taiwan) reported a case study of a patient who sustained an injury from a stabbing four years previous to surgical intervention (Spine, 29(14), 2004). Stabbing represents a more unique transection injury compared to the contusion injury that most patients with SCI have sustained. Specifically, the lesion at the T11 level was bridged with sural nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin glue containing fibroblast growth factor. Two-and-a-half years after surgery, the patient had improved from C to D on the commonly used ASIA assessment scale.

Over the 2000–2003 period, Cheng has treated 25 cases with the approach. Of these cases, 10 were cervical injuries of which seven improved in motor score and sensory scores. He has been authorized to carry out an additional 115 patients.

2) Dr. Shaocheng Zhang (Shanghai, China) has microsurgically implanted peripheral nerve segments into the injury site of patients with incomplete SCI. Specifically, after the endorachis was opened (outer enveloping layer of the spinal dura mater), various adhering fibrous bands were removed, and then autologous (i.e., from the patient), sural-nerve segments were implanted in shallow incisions that had been made slightly longer than the area of abnormality. Before implantation, the segments had been stripped of their covering connective tissue, making them resemble cauda equine tissue.  The 35 patients studied included 30 males and 5 females; ranged in age from 16 to 42 years; and had sustained their injuries 6 to 26 months (average 13) before surgery. Ten, 19 and 6 were injured in T7-9, T10-12, and L1-2 regions, respectively Thirty-two regained some ambulatory function (Photo: Zhang's surgical team).

3) Dr. Carl Kao (Quito, Ecuador) is considered one of the more controversial neurosurgeons over the past 30 years but perhaps was actually a head of his times. Building upon his early research in spinal-cord injured dogs carried out at George Washington University (Washington, DC), he started transplanting peripheral nerve segments into the injury site of humans with SCI, and, reportedly, has since treated 600 with SCI. He specifically transplants sural nerve segments from the leg into the injury site and surgically covers the area with an unattached piece of omentum reconnecting this tissue with a surrounding vascular source (see below for discussion). To enhance graft survival, patients are treated for several weeks with hyperbaric oxygen and later with the conduction-promoting drug 4-aminopyridine.