From July 2001 to the beginning of 2003, Lima’s team has operated on four female and three male patients. Three were quadriplegic and four Paraplegic. Six of the seven had ASIA-classified complete injuries. Ages ranged from 11 to 32 (averaging 22), and the time between injury and surgery varied from 1/2 to 6 1/2 years. Spinal-cord lesions ranged from 1 to 6 cm (1 cm = 39 inches) in length, although Lima believes the Lesion optimally should be less than 2-3 cm. Most injuries were contusions, similar to those sustained in car accidents. The surgery consists of harvesting olfactory tissue from the patient’s nasal cavity, preparing it, and implanting it into his or her SCI site. The procedure takes 4-6 hours, depending upon injury level and extent, presence of fixation plates or screws, etc. The patient is discharged from the hospital after 4-7 days. The critical procedure is the collection of about one fourth of the patient’s olfactory tissue through unique procedures that maximize the harvesting of that tissue and minimize the collection of closely associated nasal respiratory tissue. Although Lima’s experience indicates small amounts of contaminating respiratory tissue are innocuous, it nevertheless lacks olfactory tissue’s regenerative components. Because olfactory tissue can diminish over time, patient age is important. In contrast to other researchers who have started to implant OECs into patients with SCI, Lima uses whole olfactory tissue for transplantation without attempting to separate cellular components. He believes more than one cell type is needed to maximize Regeneration in the injured cord, including, in addition to OECs, neurons in different developmental stages and precursor stem cells. Because the graft is taken from the patient, immunosuppressive drugs are not needed to avert tissue rejection. In addition, patients regain smelling ability within several weeks. The neurosurgeon exposes the cord’s injury site with a Laminectomy and then myelotomy (cutting open the cord’s membrane coverings). Although it is impossible to remove all the scar tissue at the injury site cavity, the scar’s top and bottom stump are taken off so the cord is visible, and in between, holes are made in the scar. As the cavity is being prepared, Lima dissects the isolated olfactory tissue into 20-30 pieces while it is
Immersed in a small amount of the patient’s Cerebrospinal Fluid. The pieces are then implanted into the cavity. Lima estimates that a 1 cm cavity filled by this tissue will contain approximately 400,000 stem cells and 4 million each of mature and immature neurons and other supporting cells.
Although preliminary results are promising, Lima emphasizes that much follow-up work is needed to document long-term benefits and any delayed side effects. Because only a short time has ensued since surgery for many patients, benefits associated with neurological regeneration are not expected to fully accrue for some time. Although Lima underscores that patients should have realistic expectations and not anticipate an all-encompassing, restoration-of-function panacea, he believes even modest restored function can have profound quality-of-life benefits.
Using the ASIA standards, six of the seven patients regained some sensation and muscle control within a month of surgery. Because the seventh patient had a second undetected lesion, he did not improve.
Lima suggests this initial recovery may be due to bridging and remyelination of available axons and also perhaps to some post-surgical cord decomposition. Improvement should gradually continue with time as neurons or their axons further regenerate and grow, remyelinate, and make new connections.
This gradual improvement is demonstrated by Lima’s first patient, a 21-year-old female who sustained a C7-T1 contusion-type injury six months before surgery. She regained some sensory recovery about one month after the surgery, voluntary abdominal muscle control after two months, some gleuteus and leg abductor muscle control, including standing without leg braces after about nine months, and recently, some bladder control.
Overall, MRIs indicate substantial filling of and continuity in the lesions by the grafts, and electrophysiological assessments document voluntary muscle control.
Lima’s patients have had access to only modest postsurgical Rehabilitation. He believes maximal restored function will require much more aggressive rehabilitation.
Luis, 29, sustained a 4-cm long, clinically complete, T4-5 injury two years ago while helping a friend paint walls. After misplacing a foot, his life turned upside down. When a friend told him about Dr. Lima’s work, Luis immediately volunteered to be a candidate.
“There was much uncertainty, but I had nothing to lose,” he remembers. Luis started noticing improvements two or three weeks after his August operation. He first regained sensitivity immediately below the injury site. Then came control of abdominal muscles and recently
