Safety of intramedullary Schwann cell transplantation for postrehabilitation spinal cord injuries: 2-year follow-up of 33 cases

Clinical article

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Object

Many experimental studies on spinal cord injuries (SCIs) support behavioral improvement after Schwann cell treatment. This study was conducted to evaluate safety issues 2 years after intramedullary Schwann cell transplantation in 33 consecutively selected patients with SCI.

Methods

Of 356 patients with SCIs who had completed at least 6 months of a conventional rehabilitation program and who were screened for the study criteria, 33 were enrolled. After giving their informed consent, they volunteered for participation. They underwent sural nerve harvesting and intramedullary injection of a processed Schwann cell solution. Outcome assessments included a general health questionnaire, neurological examination, and functional recordings in terms of American Spinal Injury Association (ASIA) and Functional Independence Measure scoring, which were documented by independent observers. There were 24 patients with thoracic and 9 with cervical injuries. Sixteen patients were categorized in ASIA Grade A, and the 17 remaining participants had ASIA Grade B.

Results

There were no cases of deep infection, and the follow-up MR imaging studies obtained at 2 years did not reveal any deformity related to the procedure. There was no case of permanent neurological worsening or any infectious or viral complications. No new increment in syrinx size or abnormal tissue and/or tumor formation were observed on contrast-enhanced MR imaging studies performed 2 years after the treatment.

Conclusions

Preliminary results, especially in terms of safety, seem to be promising, paving the way for future cell therapy trials.

Abbreviations used in this paper: ASIA = American Spinal Injury Association; FAM = Functional Assessment Measure; FIM = Functional Independence Measure; SCI = spinal cord injury.

Article Information

Address correspondence to: Hooshang Saberi, M.D., M.P.H., Department of Neurosurgery, Brain and Spinal Injuries Repair Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Boulevard, Tehran 14197, Iran. email: saberih@tums.ac.ir (cc: hgsaberi@yahoo.com).

Please include this information when citing this paper: published online July 29, 2011; DOI: 10.3171/2011.6.SPINE10917.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    T2-weighted MR imaging study obtained in a patient with C-6 SCI. Note the hyperintense region at the fracture site approximately 14 mm rostrocaudally; there is minimal cord compression.

  • View in gallery

    A: Inverted microscope view of spindle-shaped cell culture. Original magnification × 4. B: Cultured cells stained with S100, showing highly positive staining. Original magnification × 10. C: Electron microscopic view of the cultured cells, demonstrating large cytoplasmic extensions.

  • View in gallery

    Intraoperative photograph (D) of the spinal cord at the lesion level. The lesion was exposed after laminectomy and durotomy under imaging guidance in coronal (A), sagittal (B), and axial (C) planes.

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