22 February 2020
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A major breakthrough for spinal cord injuries

Dr Ross Walker
18 July 2019

One of the worst traumas imaginable is to suffer a spinal-cord injury and to be left with either paraplegia or even worse quadriplegia. In Australia alone, there are over 12,000 people with spinal cord injuries, with 400 new cases a year. Of these, 15% are complete quadriplegics and 20% complete paraplegics. The typical causes are some form of motor vehicle or motorbike accidents or through the various types of body contact sports.

Surgeons at the Austin hospital in Melbourne have performed study on 16 young adults with quadriplegia, with the average age of 27. These young people had nerve transfer surgery, with or without tendon transfer surgery, in an attempt to restore some degree of their upper limb function. Some improvement in upper limb function would allow elbow extension, grasp, pinch and hand opening. The ability to perform these functions would then allow these young people to perform day-to-day activities, that the vast majority of people take for granted, such as brushing your teeth or being able to use the toilet without assistance.

This nerve transfer surgery in 13 out of the 16 adults demonstrated that these previously dependent, complete quadriplegics could feed themselves, brush their teeth and hair, write and use a variety of electronic devices. In the three people where the procedure was not successful, there were no complications. So in reality, they were not worse off, so the procedure was worth the risk. Interestingly, nerve transfer surgery was more effective when the operation was delayed for at least 12 months after the injury.

So often the media reports new therapies or studies as major breakthroughs, dashing the hope of sufferers of various conditions when they find out that the so-called breakthroughs have only been in a variety of cells in a laboratory or in experimental animals (typically mice) and the chance for the so-called breakthroughs to be available to humans can be anywhere between 5 to 20 years away, if it all.

This nerve transfer surgery, through superb Australian research, has been performed on humans with spinal cord injury and has had a clear, practical success in restoring upper limb function in this situation. Over the past few decades there have been some extraordinary approaches to treating spinal cord injury with some anecdotal marked improvements. To date, not many of these approaches have been demonstrated in clinical trials to have consistent success.

I am delighted to be able to call this a major clinical breakthrough which will hopefully, in the near future, become standard of care for people with significant spinal cord injuries.

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