Ida Fox and Amy Moore

This talk is called Advances in Peripheral Nerve Surgery and Applicability to SCI

These doctors work with actual patients.

Amy Moore is first.

It’s very inspirational to be here and learn what’s going on from a central nervous system perspective. (Holy smokes, she looks like a movie star.) She does peripheral nerve surgery, and she thinks there is a way for this to have impact on sci recovery. Your axons have their cell bodies in the cord, and they grow out of it all the way to its target muscle.

Axons grow at the rate of 1 mm per day, which = an inch a month. The problem is that by the time the axon gets to the muscle it’s too late. So what do they do with the nerve graft? You start with a gap in the tube of axons, and you need a conduit through which they can grow. One issue is that physical conduits degrade. They have a thing called an Acellularized Allograft, which comes from a cadaver. Oh, cool.

They do work. About 5 times as well as the conduits, in terms of how many axons get through. It works great for 2 cm, still good at 4 cm, but not so good at 7 or 8. What’s going on? Well, Schwann cells get stressed and become inert. They don’t produce the growth factors you need to get the axons to keep going. Basically, the Schwann cells aren’t able to do their jobs.

The gold standard, she says, would be an allograft, but they have not been able to get there. What they’re doing while they work this one out is called Nerve Transfer. (We heard about this at Working2Walk 2012 . . . link is here.) It involves taking a nerve that’s not really needed from somewhere in the body and using it to repair a damaged one. They’ve used this a lot for people who injure their shoulders in motorcycle crashes . . .

Is there a way to speed up recovery in nerves that are slowly re-growing? Yeah, they do a graft in the same way during the re-growing time. She has a patient with a damaged ulnar nerve, which causes 40% of what your hand can do. A hand with an ulnar nerve deficit looks a lot like a quad hand. The patient’s nerve was growing, but it was probably going to be too slow . . . so she did the surgery that re-wired the girl’s nerve.

And there’s a video up with this girl’s two hands both working perfectly.


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