Olfactory mucosal autografts and rehabilitation for chronic traumatic spinal cord injury.
OBJECTIVE
Basic science advances in spinal cord injury (SCI) are leading to novel clinical approaches. The authors report a prospective, uncontrolled pilot study of the safety and outcomes of implanting olfactory mucosal autografts (OMA) in 20 patients with chronic, sensorimotor complete or motor complete SCI.


METHODS
Seven paraplegic and 13 tetraplegic subjects (17 men and 3 women; 19-37 years old) who sustained a traumatic SCI 18 to 189 months previously (mean = 49 months) were enrolled. Preoperative rehabilitation that emphasized lower extremity stepping using either overground walking training or a robotic weight-supported treadmill training was provided for 25 to 39 hours per week for a median of 4 months at 3 sites. No change in ASIA Impairment Scale (AIS) motor scores for the lower extremities or AIS grades of completeness was found. OMAs were transplanted into 1.3- to 4-cm lesions at C4-T12 neurological levels after partial scar removal. Therapy was continued postoperatively. Preoperative and postoperative assessments included AIS scores and classification, electromyography (EMG) of attempted voluntary contractions, somatosensory evoked potentials (SSEP), urodynamic studies with sphincter EMG, spinal cord magnetic resonance imaging (MRI), and otolaryngology and psychology evaluations. The Functional Independence Measure (FIM) and Walking Index for Spinal Cord Injury (WISCI) were obtained in 13 patients.


RESULTS
All patients survived and recovered olfaction. One patient was rehospitalized for aseptic meningitis. Minor adverse events occurred in 4 others. The mean duration of follow-up was 27.7 months (range = 12-45 months). By MRI, the lesion site was filled in all patients with no neoplastic overgrowth or syringomyelia. AIS grades improved in 11 of 20 patients, 6 (A --> C), 3 (B --> C), and 2 (A --> B), and declined in 1 (B --> A). Improvements included new voluntary EMG responses (15 patients) and SSEPs (4 patients). Scores improved in the FIM and WISCI (13/13 tested), and urodynamic responses improved in 5 patients.


CONCLUSIONS
OMA is feasible, relatively safe, and possibly beneficial in people with chronic SCI when combined with postoperative rehabilitation. Future controlled trials may need to include a lengthy and intensive rehabilitation arm as a control.
Lima
Carlos
C
Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. carlosvlima@sapo.pt
Escada
Pedro
P
Pratas-Vital
José
J
Branco
Catarina
C
Arcangeli
Carlo Alberto
CA
Lazzeri
Giovanna
G
Maia
Carlos Alberto Santana
CA
Capucho
Clara
C
Hasse-Ferreira
Armando
A
Peduzzi
Jean D
JD
D000328:Adult; D002908:Chronic Disease / Q000534:rehabilitation / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods; D009474:Neurons / Q000637:transplantation*; D009831:Olfactory Mucosa / Q000166:cytology / Q000637:transplantation*; D010243:Paralysis / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D012371:Robotics; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult