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Surgery lets man walk away from potential paralysis Add to ...

A fall in his bathroom a year ago left Trevor Griffith as helpless as a newborn.

In January, 2008, after an earlier tumble in his snowy driveway, the 58-year-old banker had a muscle spasm and fell backward to the bathroom floor. He couldn't get up. He couldn't move his arms, legs or anything below his neck.

Mr. Griffith was taken to the local hospital, and a few days later was transferred to Toronto Western Hospital, where he met Michael Fehlings, a surgeon who specializes in an experimental operation that can help people with severe spinal-cord injuries walk again.

Dr. Fehlings told Mr. Griffith that the ligament that runs through the vertebrae in his neck had been hardening for years, probably the result of a fall the Mississauga man remembers having in the parking lot of a bowling alley 30 years ago. The ligament had turned to bone, compressing the nerves that carry messages from his brain to his muscles. The fall in the bathroom was a final insult.

Decompression surgery offered the best hope of recovery, Dr. Fehlings explained. It involves freeing the area around the spinal-cord of any bone, blood or other tissue putting pressure on it. It can also be used to realign the spine, and Dr. Fehlings is conducting a clinical trial to see whether it can reduce the paralysis that can follow acute spinal-cord injuries caused by car accidents, falls and other mishaps.

So far, 200 patients have been enrolled in the experiment, which is designed to determine whether the surgery helps people regain the ability to move if done within 24 hours of an injury to the neck. Toronto Western and Vancouver General Hospital are two Canadian hospitals involved, along with Thomas Jefferson University in Philadelphia and the University of Maryland. Dr. Fehlings presented preliminary results this spring at the annual meeting of the American Association of Neurological Surgeons in Chicago.

"One in five are walking away when they wouldn't normally walk away," he said.

He is hoping the work will lead to new protocols for more urgent surgical intervention for people with spinal-cord injuries.

"Many patients with cervical spinal-cord injury are not undergoing decompressive surgery and that is something that I hope to change," said Dr. Fehlings, who is medical director of the Krembil Neuroscience Centre and head of the spinal program at Toronto Western Hospital. He is hoping the work will lead to new protocols for more urgent surgical intervention for people with spinal-cord injuries.

Mr. Griffith wasn't part of the clinical trial because he didn't undergo the surgery until a few days after he fell. But Dr. Fehlings said he has had the best results of any of his patients.

After extensive rehabilitation, he is walking again and is getting ready to return to his job at the Royal Bank of Canada in January.

"If it hadn't been for the surgery I probably wouldn't be walking," Mr. Griffith said.

Medicine is on the cusp of a revolution in the treatment of severe spinal-cord injuries. Twenty or 30 years ago, there was little doctors could do for people like Rick Hansen, who was a teenager in 1973 when he was thrown from the back of a pickup truck and lost the use of his legs.

Today, with the help of money raised by the Rick Hansen Foundation, Dr. Fehlings and his colleagues are investigating more than one approach for repairing, rebuilding and reconnecting damaged spines.

They are trying to find ways to treat the second wave of injury that occurs after an accident, when blood flow to the area is choked off.

"It can be thought of almost like a stroke of the spinal cord," Dr. Fehlings said. "You can get an imbalance in salt, an influx of sodium and calcium, and this causes further damage to the nerve cells."

In 2009, Toronto Western Hospital will be part of a new clinical trial of a drug, called riluzole, designed to reduce the amount of secondary damage.

Another experiment is already under way to assess a protein that may help stimulate the regeneration of nerve cells after an accident. Preliminary results suggest it deserves a thorough evaluation.

"We have had some patients recover the ability to walk. In other cases, it is less spectacular: improvements in hand function, improvement of sensation," Dr. Fehlings said. But a randomized trial - some patients will get the drug and others won't - is required before doctors know if it really works.

Dr. Fehlings is also pushing for a world first - an experiment to see whether stem cells can rebuild damaged human spines.

In the developing embryo, stem cells have an endless capacity for self-renewal and give rise to every type of cell in the body - skin, muscle, bone, heart, liver, kidney, brain and more than 250 other kinds of specialized cells. Could they be injected into the spinal column to rebuild it after a devastating injury?

Dr. Fehlings is working with neural stem cells, which are further along in their development than embryonic stem cells. They can develop only into nerve cells; they can't make bone, cartilage or anything else.

But they can make cells that produce myelin, the insulation that covers nerves and allows them to work at high speeds. The cells that make it are sensitive, and tend to die after a spinal-cord injury.

In mice, the neural stem cells kick-started myelin production. In humans, the idea is to use what's left of a damaged spinal cord as scaffolding and reconstruct the missing layer of insulation around nerve fibres that survived the initial injury.

There are a number of neural stem-cell lines available. Dr. Fehlings is hoping to get the required approvals to try one of them in humans within the next 18 months. "I argue that we are in fact ready to go into clinical trials," he said.

But stem cells offer hope to only about half the 1,100 Canadians who suffer traumatic spinal-cord injuries every year. "There needs to be a critical number of nerve fibres left," Dr. Fehlings said.

That wasn't the case for Carolyn Pioro, a Toronto gymnast turned professional acrobat who in 2005 was involved in a mid-air collision while rehearsing on a trapeze. She hit the 200-pound man who was supposed to catch her.

"I got tossed into the air, spinning out of control. I landed on my neck. To me, it was audible, a snapping, almost an electric shock. I was in the net but couldn't feel anything else," Ms. Pioro said.

Her spinal cord was completely severed. The decompression surgery done at Toronto Western may have helped save her life, and it allowed her to get off a respirator. But doctors told her there was no chance she would ever walk again.

Today, the 29-year-old is studying at Ryerson University and pursuing a career in magazine publishing. She can get around in a motorized wheelchair.

"I drive it with my head," she said.

 

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