Object: The efficacy of olfactory mucosa autograft (OMA) for chronic spinal cord injury has been reported. New activity in response to voluntary effort has been documented by electromyography (EMG), but the emergence ...Object: The efficacy of olfactory mucosa autograft (OMA) for chronic spinal cord injury has been reported. New activity in response to voluntary effort has been documented by electromyography (EMG), but the emergence of motor evoked potential (MEP) reflecting electrophysiological conductivity in the central nervous system, including the corticospinal pathway, after OMA, and the best indications for OMA, have not been clarified. Here, we report the emergence of MEPs after OMA and offer recom-mendations for appropriate indications based on the presence of involuntary muscle spasm (IMS). We used analysis of MEP to examine the efficacy of OMA for patients with complete paraplegia due to chronic spinal cord injury. To clarify the indications for OMA, we investigated the association of IMS and efficacy of OMA. Methods: Four patients, 3 men and 1 woman, were enrolled. The mean age of the cases was 30.3 ± 9.5 years (range, 19 to 40 years). All 4 cases were American Spinal Injury Association (ASISA) grade A. The mean duration from injury to OMA was 95.8 ± 68.2 months (range, 17 to 300 months). Samples of olfactory mucosa were removed, cut into smaller pieces, and grafted into the sites of spinal cord lesions after laminectomy. Postoperative subcutaneous fluid collection, postoperative meningitis, postoperative nosebleed, postoperative infection in the nasal cavity, impaired olfaction, neoplastic tissue overgrowth at the autograft site, new sensory disturbance, and involuntary muscle spasm were investigated as safety issues. Improvements in ASIA grade, variations in ASIA scores, EMG, SSEP, and improved urological function were evaluated as efficacy indicators. Results: There were no serious adverse events in this series. In 2 of the 4 cases, an improvement in motor function below the level of injury was recognized. In one, the motor score was 50 until 16 weeks after surgery, and it increased to 52 from 20 weeks after surgery. In the other, the motor score was 50 until 20 weeks after surgery, and it increased to 52 at 24 weeks after surgery with a further increase to 54 at 48 weeks after surgery. The emergence of MEP was recognized in the latter case at 96 weeks after surgery. The other 2 cases had no improvement in ASIA motor score. Both of these cases who showed improvements in the ASIA motor scores exhibited relative IMS compared with those who had no ASIA motor score recovery. Conclusions: We recognized the emergence of MEPs in a case with complete paraplegia due to chronic spinal cord injury after OMA. IMS might be a candidate of indication of OMA.展开更多
Object: The inability of the spinal cord to regenerate after SCI is due to the extremely limited regenerative capacity of most central nervous system (CNS) axons, along with the hostile environment of the adult CNS, w...Object: The inability of the spinal cord to regenerate after SCI is due to the extremely limited regenerative capacity of most central nervous system (CNS) axons, along with the hostile environment of the adult CNS, which does not support axonal growth. It seems that for successful axonal regeneration to take place, a supportive local environment is required after the injury. We have previously reported that transplantation of the olfactory mucosa is effective in restoring functional recovery in rats following spinal cord transaction. In this study, we examined histological features of olfactory mucosa grafts in rats subjected to a spinal cord contusion protocol. Respiratory mucosa was utilized as a control, as we have previously found that respiratory mucosa does not support neuronal generation. Methods: The rats spinal cords were crash-injured by dropping a 10-g metal rod from a height of 7.5 cm, and a couple of weeks later, the injury sites were exposed, and both olfactory and respiratory mucosae were inserted into the posterior sulcuses of the spinal cord. The each number of olfactory and mucosa transplanted rats were five. The Basso, Beattie, and Bresnahan (BBB) score was observed. Immunohistochemical study for neurofilament was performed. Results: Olfactory mucosa transplanted rats following spinal cord injury can support at least partial hind limb motor recovery compared with respiratory mucosa transplanted rats and we identified numerous axons surrounding the transplanted olfactory mucosa cells, and penetrating the olfactory mucosa at the transplant site. Conclusion: Olfactory mucosa might be a suitable scaffold for axonal regeneration.展开更多
文摘Object: The efficacy of olfactory mucosa autograft (OMA) for chronic spinal cord injury has been reported. New activity in response to voluntary effort has been documented by electromyography (EMG), but the emergence of motor evoked potential (MEP) reflecting electrophysiological conductivity in the central nervous system, including the corticospinal pathway, after OMA, and the best indications for OMA, have not been clarified. Here, we report the emergence of MEPs after OMA and offer recom-mendations for appropriate indications based on the presence of involuntary muscle spasm (IMS). We used analysis of MEP to examine the efficacy of OMA for patients with complete paraplegia due to chronic spinal cord injury. To clarify the indications for OMA, we investigated the association of IMS and efficacy of OMA. Methods: Four patients, 3 men and 1 woman, were enrolled. The mean age of the cases was 30.3 ± 9.5 years (range, 19 to 40 years). All 4 cases were American Spinal Injury Association (ASISA) grade A. The mean duration from injury to OMA was 95.8 ± 68.2 months (range, 17 to 300 months). Samples of olfactory mucosa were removed, cut into smaller pieces, and grafted into the sites of spinal cord lesions after laminectomy. Postoperative subcutaneous fluid collection, postoperative meningitis, postoperative nosebleed, postoperative infection in the nasal cavity, impaired olfaction, neoplastic tissue overgrowth at the autograft site, new sensory disturbance, and involuntary muscle spasm were investigated as safety issues. Improvements in ASIA grade, variations in ASIA scores, EMG, SSEP, and improved urological function were evaluated as efficacy indicators. Results: There were no serious adverse events in this series. In 2 of the 4 cases, an improvement in motor function below the level of injury was recognized. In one, the motor score was 50 until 16 weeks after surgery, and it increased to 52 from 20 weeks after surgery. In the other, the motor score was 50 until 20 weeks after surgery, and it increased to 52 at 24 weeks after surgery with a further increase to 54 at 48 weeks after surgery. The emergence of MEP was recognized in the latter case at 96 weeks after surgery. The other 2 cases had no improvement in ASIA motor score. Both of these cases who showed improvements in the ASIA motor scores exhibited relative IMS compared with those who had no ASIA motor score recovery. Conclusions: We recognized the emergence of MEPs in a case with complete paraplegia due to chronic spinal cord injury after OMA. IMS might be a candidate of indication of OMA.
文摘Object: The inability of the spinal cord to regenerate after SCI is due to the extremely limited regenerative capacity of most central nervous system (CNS) axons, along with the hostile environment of the adult CNS, which does not support axonal growth. It seems that for successful axonal regeneration to take place, a supportive local environment is required after the injury. We have previously reported that transplantation of the olfactory mucosa is effective in restoring functional recovery in rats following spinal cord transaction. In this study, we examined histological features of olfactory mucosa grafts in rats subjected to a spinal cord contusion protocol. Respiratory mucosa was utilized as a control, as we have previously found that respiratory mucosa does not support neuronal generation. Methods: The rats spinal cords were crash-injured by dropping a 10-g metal rod from a height of 7.5 cm, and a couple of weeks later, the injury sites were exposed, and both olfactory and respiratory mucosae were inserted into the posterior sulcuses of the spinal cord. The each number of olfactory and mucosa transplanted rats were five. The Basso, Beattie, and Bresnahan (BBB) score was observed. Immunohistochemical study for neurofilament was performed. Results: Olfactory mucosa transplanted rats following spinal cord injury can support at least partial hind limb motor recovery compared with respiratory mucosa transplanted rats and we identified numerous axons surrounding the transplanted olfactory mucosa cells, and penetrating the olfactory mucosa at the transplant site. Conclusion: Olfactory mucosa might be a suitable scaffold for axonal regeneration.
