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   >>Spinal Cord Injury >>Octavian Adrian Nita(Romania)
Octavian Adrian Nita(Romania)
Octavian Adrian Nita(Romania)
2009-3-3


Octavian Adrian Nita, a 26-year-old male from Romania, admitted to this clinic on January 15, 2009, with an eight years and six months history of motor and sensation dysfunction of four limbs and trunk due to diving accident. His metal status was clear after the accident followed with four legs’ dysfunction of movement and sensation. He was sent to the nearest hospital immediately. After emergency CT scan, compression fracture of vertebral body at the level of C4 followed with spinal cord injury at the same segments was noticed. Decompression plus insertion of internal fixation was done two days after the accident. His neurological function returned gradually. Sensation of his whole body started to recover one month after the operation. Six months later, his sensation returned partially and he was able to move his elbow and wrist joints bilaterally. He was able to feel his bladder and bowel movement without any control. January of 2008, he was done the procedure of removing of the internal fixation by his local doctors without any positive effects. Until the admission, his muscle atrophy gradually throughout due to no rehabilitations.
 
DIAGNOSIS: Traumatic Chronic Spinal Cord Injury (C4 ASIA B)
 
PHYSICAL EXAMINATION: Mental Status was clear. Cranial nerves: Pupils were equal, round, and reactive to light and accommodation. Tongue was midline and no atrophy and fasciculation. Motor: elbow flexors was 5 grades bilaterally; wrist extensors was 3 grades bilaterally; elbow extensors was 3 grade on the right and 1 left; finger flexors (distal phalanx of middle finger) and finger abductors (little finger) was 0 bilaterally. Strength of his lower limbs was 0 bilaterally. Tone of upper and lower extremity was mild increased. Deep tendons reflexes were 2+ on his arms and 3+ on his legs. Patellar clonus and ankle clonus were positive bilaterally. Babinski sign and Hoffmann sign were positive bilaterally. Sensation: Light touch decreased at the level of T11-12, L2-4, and S1-5 on the right and T11-S5 on the left, and disappeared on the level of L1, L5 on the right. Pin prick disappeared on the level of C5, T4-S5 on the right and C6, C8, T5-S5 on the left. Abdominal reflex and cremasteric reflex were not elicited. He had difficulty to perform the finger-to-nose test and heel-knee-tibia test due to the decreasing of power in his limbs.
 
l         ASIA motor score was 11 points on the right, left 9 points.
l         ASIA light touch score was 42 points on the right, left 44 points.
l         ASIA pin prick score was 18 points on the right, left 18 points.
l         Score of Xishan Hospital Spinal Cord Injury Functional Rating Scale was 7 points.
 
Pre-operative pulmonary function test showed that VC 1.83L, FVC 1.92L, MVV 95.4L/min, MV 11.78L/min, PE max 31.2cmH2O, PI max 48.3 cmH2O.
 
Electromyography (EMG) showed that spontaneous potentials could be recorded in part of the muscles. Recruitment of maximal voluntary contraction was decreased in Ext Carpi Rad Long muscles bilaterally and Biceps R muscle. No motor unit potential could be recorded in Ext Dig Communis muscles bilaterally. Stimulation of median nerves and tibia nerves bilaterally with recording from cortex revealed no responses bilaterally. The PVSEP could be recorded above C7 bilaterally and could not be recorded in T2 bilaterally.
 
OPERATIVE PROCEDURE: Following the procedure of cell HLA-matching between the donor (DRB1* 09, 15) and recipient (DRB1* 13, 16), under the general anesthesia, the olfactory ensheathing cells transplant with fetal brain cells was performed on January 20, 2009. 100 µliters containing one millions olfactory ensheathing cells and two millions fetal brain cells were injected into spinal cord of patient at the both sides of the segment of C4.
 
Intrathecal implantations of fetal neural stem cells by lumbar puncture at the L3-L4 interspace were done on February 1 and 9, 2009, 500 µliters containing two millions stem cells were injected each time.
 
POST-OPERATIVE COURSE: Eight days after surgery, the stitches were removed smoothly. He underwent the adjunct regimens including the physical therapy, electric instrument exercises, electric bicycle exercises, standing board and acupuncture therapy during the whole admission. At discharge, the patient’s neurological function was a little bit better than before operation. Strength of his left arm a little bit better than before. Sensation was better because he was able to feel the pain somewhere on his trunk and legs.
 
l         ASIA motor score was 11 points on the right, left 10 points.
l         ASIA light touch score was 46 points on the right, left 46 points.
l         ASIA pin prick score was 35 points on the right, left 39 points.
l         Score of Xishan Hospital Spinal Cord Injury Functional Rating Scale was 7 points.
 
Post-operative pulmonary function test showed that VC 1.85L, FVC 1.84L, MVV 100.80L/min, MV 10.92 L/min, PE max 33.9cmH2O, PI max 43.2cmH2O.
 
EMG compared with the pre-operative EMG: The recruitment of maximal voluntary contraction was changed in Biceps R muscle. Its pattern was improved and more intensive than pre-operative EMG. The SEP and PVSEP showed no change.
 
      When the patient left this clinic on February 13, 2009, he stated that: “I can feel more pain feeling on my body.”
 
Email address of this patient: cosworth@clicknet.ro
 
Edited by Jiang Zhao, M.D. & Liu Yancheng, M.D.
 
 
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