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Ray of hope for patients with spinal cord injury

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LUCKNOW: Pace of life subdues with age. For 56-year-old Saroj things may be worse. She fell from her roof-top in Basti last week and turned quadraplegic (paralysis of all four limbs) after suffering an acute spinal cord injury. Post-primary treatment, she was referred to Chhatrapati Shahuji Maharaj Medical University’s (CSMMU) traumatic paraplegia unit.

Doctors were of the view that except for a miracle, Saroj’s life would be restricted to a wheelchair once she recovered. May be not now. She underwent a marathon surgery on Saturday. Six months of care, nursing and physiotherapy may make her walk with the help of a support.

“We undertook the omentum transposition surgery on Saroj,” said prof RN Srivastava, in-charge traumatic paraplegia unit. Omentum is the lining that covers stomach and other organs in the abdomen, while omentum transposition is a 7-8 hours surgical procedure.

In omentum transposition, surgeons cut the abdominal cavity to separate omentum from the colon and the stomach, without hampering blood and lymphatic circulation of the layer. It is then surgically tailored; placed over the injured part and sutured (stitched). Over the period of time, the omentum helps in healing of the wound.

Prof Srivastava said that pioneer of the surgery, Dr Harry Goldsmith guided CSMMU’s team to conduct the operation. “Known for its regenerative properties, it can breathe a new life into injured organs,” said Dr Goldsmith. He also enumerated some characteristics of the magical layer.

Both Dr Srivastava and Dr Goldsmith are of the view that the surgery may offer some hope to victims of acute spinal cord injury. The medical university is now working to start the surgery on a regular basis in patients’ interest. “We see some 450-500 cases of acute spinal cord injury in our unit every year. About 40% of these patients suffer with complete disability,” said prof Srivastava.

In a specific case of acute spinal cord injuries, explained the doctors, scarring of the spinal cord takes place as wounds heal. The scar, however, acts as a barrier for neurological recovery as it affects normal blood supply. In the course of time, loss of tissues translates into an almost irrevokable loss. Omentum transposition checks formation of scar and rejuvenates blood supply. This helps in avoiding the loss of the cord.

Dr Goldsmith estimates, about 40% of omental spinal cord injury patients have regained some function. Chinese surgeons have reported an even greater improvement rate. But the technique encountered criticism in 1996, when a study conducted by Clifton and his team appeared to provide the evidence to dismiss omental transposition as a viable treatment for spinal cord injuries.

In this study, 11 patients with SCI were examined a year after omental surgery. Results were inconclusive; some subjects improved, and others did not. Because these ambiguous results were associated with side effects, the investigators concluded that there was no justification for further clinical trials of this procedure. However, soon after Goldsmith rebutted this criticism.

The operating team also included vice-chancellor Prof Saroj Chooramani Gopal, Dr Abhijit Chandra, Dr Himanshu Bansal and anaesthetists Dr Monika Kohli and Dr Kanaujia.

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