November 11, 2014
Back in April I wrote a blog exploring the research that revealed how a tongue piercing could help people with spinal cord injuries. Since then I have kept a watchful eye out for new treatments or innovations that may offer help for those suffering from spinal cord injury.
I was therefore thrilled to read the recent story of 40 year old Polish man Darek Fidyka, previously completely paralysed from the waist down, who has now been able to walk following years of research and pioneering surgery.
Mr Fidyka's Story
Four years ago a horrific knife attack left Mr Fidyka paralysed from the waist down after his spinal cord was cut. Following this horrendous incident he showed little sign of recovery despite many months of intense physiotherapy treatment.
This led to Mr Fidyka becoming part of a large research team composed of surgeons at Wroclaw Medical University in Poland, and scientists from the University Hospital in London. They were also supported by fundraisers in Britain and Poland, and in particular David Nicholls, who helped fund the research through a foundation called Nicolls Spinal Injury Foundation which he set up as a tribute to his 18 year old son left paralysed after a swimming accident in 2003.
The all important breakthrough came after over four decades of research by Professor Geoff Raisman from the University College London, Institute of Neurology, alongside support from the UK Stem Cell Foundation (set up in 2007 to speed up research). The central discovery has been a new treatment called Olfactory Ensheathing Cells (OECs), which represents the most significant breakthrough following years spent studying how to repair the spinal cord. No-one ever thought regeneration of the spinal cord would be possible, but that now appears to have been turned on its head.
Repurposing the sense of smell
OECs are basically specialist nerve-supporting cells from the nose, which are regrown and then put into the spinal cord. The OECs work to assist the repair of damaged nerves that transmit smell messages, and do so by opening up pathways for them to reach the olfactory bulbs in the forebrain. The key factor is that when the cells are relocated to the spinal cord they appear to enable to ends of the severed nerve fibres to grow and join together.
Mr Fidyka became involved in the process when he agreed to work alongside the research team and undergo surgery to receive a transplant of cells taken from his nose into his spinal cord.
The overall process involved two operations. The first one was to open up his skull and remove one of the two olfactory bulbs at the base of the brain so that the olfactory ensheathing cells could then be grown in a culture.
How the spinal injury was treated - image from http://www.bbc.co.uk/news/health-29645760
Two weeks later the second operation involved exposing the damaged spinal cord and transplanting the cells. This involved 100 micro injections of OECs made above and below the damaged area of the spinal cord. Four strips of nerve tissue were then placed across an 8mm gap in the spinal cord. Scientists believe the OECs act as a critical pathway in stimulating the spinal cord cells to regenerate, using the nerve grafts as a bridge to cross the severed cord.
The Miraculous Results
About three months later Mr Fidyka first noticed that his left thigh had started to develop muscle. Six months later he was able to take his first steps along parallel bars using leg braces. Two years on he can now walk outside using a frame and even drive a car. He has also recovered some bladder and bowel sensation, sexual function and sensations such as hot and cold and pins and needles.
But with these reported breakthroughs, we must always remain cautious but optimistic. Those living with spinal cord injuries are all too aware of headlines promising 'miracle' cures, and must always be vigilant in reading between the lines on such reports. Dan Burden, a spokesperson for the UK's Spinal Injuries Association, who broke his back in a fall while on holiday 13 years ago, said:
"The reality is that there is a long way to go before this is a treatment that can be applied to spinal cord-injured people; there will also be question marks about whether this treatment would work for someone who has been injured for many years.
But they are the first studies we've seen that may well lead one day to the repair or a solution to a spinal cord injury."
However, even taking this important approach into consideration, the number of paralysed people in the world is colossal, and this breakthrough cannot be dismissed. If the global neurosurgeon community can be convinced that this medical marvel really does work, then we must be open to its potential in changing people's lives forever.
The door to realising that our nervous system really does have the ability to repair itself is now tentatively open, and we should all be cautiously optimistic for future treatments.