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Cutting-edge surgery soon for paralysed Kiwis

Published: 6:46PM Wednesday March 18, 2009 Source: ONE News

New Zealand doctors are on the verge of getting approval for cutting-edge surgery that could help the paralysed feel or even walk again.
The experimental procedure, which has only been attempted in a few countries, uses the patient's own stem cells to try to repair the severed spinal chord.

Some say the procedure will offer a ray of light for the paralysed, but others warn the procedure is still in its early stages to be sure.

Scientists have been working on this project in a purpose built lab for the past six years in New Zealand, growing cells from human bone marrow.

But in patient trials they will be using what's called olfactory cells, from high up in the spinal patient's own nose.

They are the only nerve cells in the body which continually replace themselves.

Dr Jim Faed, the clinical research trial leader, says there can be regeneration and repair in the spinal cord induced by those cells.

Pending final ethics committee approval, doctors will recruit 12 spinal patients for phase one surgical trials at Dunedin Hospital.

It'll be a two-stage surgical process, using the patients own adult stem cells.

In the first stage, one surgeon will remove slivers of cell tissue from the patient's nose.

Then a neurosurgeon will open up the patient's spine and re-plant those cells into the spinal cord injury site. Results would take months to show.

Caution sought

But Faed is cautious about the results of the trial.

"Are patients going to get up and walk a month later? No, that's not going to happen, it's not that dramatic," says Faed.

A team in Portugal has already carried out over 100 such operations. 

Dunedin neurosurgeon Grant Gillett has flown to Lisbon twice to observe the surgery and patient recovery.

"It led me to believe that there was some measurable benefit, it was subtle, but it seemed measurable," says Gillett.

Clinical trials on 69 patients have shown no major adverse side effects, aside from post-operative pain.

One or two have reportedly regained movement down to thigh level, while others have regained limited bowel and bladder function.

But doctors concede most have had only slight improvement and some none at all.

"This is an experimental procedure. If you had it, the people doing it for you could not guarantee you any benefit," says Gillett.

Those who are sceptical of the procedure, like Dr Shaun Xiong, who heads the Burwood Spinal Unit in Christchurch, has concerns that it's just too experimental.

The Burwood Spinal Unit specialised in spinal injuries for a nation that is rated as leading the world in spinal injuries, where one person is paralysed every five days.

"I believe at this stage the science is not quite there for the clinical trial, particularly if people jump in and offer it as a treatment option," says Dr Shaun Xiong, of the Burwood Spinal Unit.

He also has concerns Dunedin Hospital doesn't have the expertise to treat spinal patients.

But one of the patients at Burwood thinks otherwise.

Courtney Edmonds, a tetraplegic patient, who has been paralysed since a car accident four years ago, is supportive of the procedure.

"I think just to be able to move my fingers again would mean far more to me than actually walking," says Edmonds.

Courtney says any risk is one he'd be prepared to take.

Noela Vallis, of the NZ Spinal Cord Society, says the procedure may have its benefits, as she believes there are too many people suffering who don't have to.

Vallis set up the NZ Spinal Cord Society, which now has its own research lab at Otago University.    

But the green light has yet to be given for the procedure and the decision is still being mulled over.

The Regional Ethics Committee has given conditional approval but is meeting next month to consider giving final approval.

If that's granted, a fundraising campaign will be needed to fund the first 12 operations.

Then they'll start recruiting patients, looking first for patients with thoracic spine injury that's chest height before the first operation at Dunedin Hospital hopefully by mid-year.

As with all phase one clinical trials, the first operation is purely to establish if it's safe and whether there is any benefit to be gained.