A 48 year old man, we’ll call Hank, fell off a ladder and broke his back. He suffered a complete spinal cord injury and had no feeling or movement from the waist down. Doctors were able to get him in the operating room within 48 hours of his injury where they performed an experimental new surgery. They used a nerve from Hank’s chest to perform a spinal cord bypass. Dr. Christopher Winfree from the Center for Peripheral Nerve Surgery and colleagues published Hank’s case study this year in the February Issue of Neurosurgical Focus.
When the spinal cord is completely severed, all feeling and movement below the level of injury is instantly cut off. The spinal cord won’t heal on its own and surgeons can’t repair it. However, the nerves that branch off of the spinal cord, peripheral nerves, can be repaired. These are nerves that give us feeling and movement in our arms and legs. Peripheral nerves, like a gecko’s tail, can regenerate. This process can take years, depending on the length of the nerve, but it is possible, nonetheless.
Dr. Winfree currently heads the Center for Peripheral Nerve Surgery Laboratory where he is researching the possibility of using peripheral nerves to bypass the site of spinal cord injury and return sensation and movement where is has been lost.
The peripheral nerve that Hank’s surgeons chose was an intercostal (between the ribs) nerve. These nerves travel around to the chest and help us breathe. They detached one of these long nerves, re-routed it below the level of Hank’s injury, opened the lining that protects the spinal cord and slipped the end of the nerve inside.
After the surgery, Hank went through the usual eight weeks of inpatient rehabilitation to learn how to cope with his spinal cord injury. Five months after his surgery, Hank started to report some feeling in his thighs. At ten months after surgery Hank started to move his leg at the hip. What was curious was he could move his leg best when he held his breath (something the intercostal nerves help us do). Spontaneous movements of his leg were also coordinated with his breath. It is impossible to say for sure whether some of Hank’s recovery would have happened anyway, but it sure looks like it was the bypass that breathed new life into Hank’s legs.
Click here to learn more about spinal cord injury.
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