Case Study

Patient F,

Male, Canadian

Patient Overview

Age at time of treatment: 18 – 25
Injury Level: C5
Treatment Received: Epidural Stimulation
Location of Treatment: Thailand
Time between injury and treatment: 2 – 5 years
Date of Surgery: 25/06/2018
Date of Discharge: 21/07/2018

Condition on Admission

Patient sustained a C5 level spinal cord injury on November 12th, 2015, during a hockey game. Initial diagnosis of ASIA A score was changed to ASIA B within a few weeks of the trauma. Patient has no hand or leg function. Triceps and core strength were initially very weak, but have improved with time. Patient has neurogenic bowel and bladder function but is otherwise a healthy individual with no secondary injuries or diagnoses present.

Previous Therapies & Treatments

Patient had not received any surgery since his injury besides broken vertebrae repair. Patient received mesenchymal stem cells and allogenic stem cells, in the form of IV infusion and lumbar punctures, as well as physical rehabilitation. This resulted in minor improvements in his functions.

Verita Neuro Treatment Received

After a spinal MRI scan, an EMG, and comprehensive blood work, patient underwent laminectomy and epidural spinal cord stimulator implantation on June 25th, 2018. The device is the ‘Medtronic Restore Advance 16-electrode MRI Compatible Device’. The surgery was completed without issue and no serious complications were reported during the postoperative hospital stay. Surgical wounds healed normally and no spinal cord or superficial wound infection was reported.

Results

Motor Functions
Sensory Functions
Autonomic Functions

Improvements were noticed in gross motor skills, including the ability to stand and step with support. Balance and coordination improved significantly with treatment and training, and physical therapy led to improvements in patient’s stamina and muscle mass.

Improvement in sensory function was neither observed, nor expected, as the patient’s treatment did not include stem cell injections.

N/A

After 35 days, patient was discharged to continue his physiotherapy back home.

Improvements are monitored in 15 targeted areas: 11 Motor areas and 4 Sensory areas. However, the number of targeted areas may vary depending on patient’s condition prior to admission. If patient does not experience symptoms in certain Motor/Sensory functions, or is not impaired in a speciﬁc targeted area prior to surgery, it is excluded from the report (Not Applicable). If there is progress in any given area — either mild, moderate, or signiﬁcant — it is measured and reported as positive (“Yes”). No improvement, the existence of pain or spasms, or an inability to perform a measured function is reported as “No”.

Results Interpretation

In this patient, neuropathic pain was not present, therefore 14 areas instead of 15 were reviewed. The primary treatment focus was to regain motor functions, which improved in 10 out of 11 targeted areas when the epidural stimulation device was switched on. Patient did not receive any stem cell injections therefore no improvements were visible in the 3 sensory function areas.

One Month Follow Up

Motor Functions
Sensory Functions
Autonomic Functions

One month after discharge, patient exhibited moderate improvement in stepping with support with less pronounced improvement observed in standing with support. While there were no discernable improvements to gross or fine motor skills, the remaining motor function categories all showed small-to-moderate improvement. Patient did not participate in any physical therapy after returning back home, which resulted in weaker upper limb and trunk control.

Balance and coordination improved moderately, and further improvements in muscle mass and stamina are anticipated with continued physical therapy. Patient can now sit up straight in his wheelchair and coordinate movement of his left and right foot during physical therapy. Patient is not able to lock knees yet and needs assistance in foot placement when stepping.

As expected, since the patient’s treatment did not include stem cell injections, there was no improvement in sensory function at the one-month follow-up evaluation.

Spasms are reduced when the stimulator is on, but when it isn’t, hip flexor and quad-extension spasms are still present with the same frequency as prior to surgery. Spasticity is also reduced during sleep, and patient experiences stronger hip abduction and knee bend due to increased muscle strength.

Six-Month Follow Up

The patient is undertaking 18 to 19 hours of therapy per week.
Overall, patient is very satisfied with his outcomes after the Epidural Stimulation surgery. He will continue his physical therapy and another feedback call will be made in 3 months time.
Patient says “Since the treatment I’ve had new hope and energy towards my recovery. The epidural stimulator has been a great tool for exercise therapy and has had multiple beneﬁts in my daily life. The potential to stand and take steps is extremely exciting. It keeps me motivated everyday and hopeful about the future.”

Motor Functions
Sensory Functions
Autonomic Functions

Patient still requires assistance when changing position from sitting to standing. When standing, patient still requires assistance in locking his knees, but is able to lock his hips.

He has noticed significant improvements during stepping training and is able to use a hoist to take assisted steps on a treadmill. Patient is able to lift his feet by himself and is more consistent and coordinated, but requires assistance in foot placement and locking his knees.

There is no visible change in the patient’s muscle mass, but he reports that his core muscles are getting stronger.

N/A

Patient noticed that when he switches on Program N, which contracts his abdominal area, he is able to empty his bowel faster, resulting in shorter time spent in the bathroom.

Patient also noticed that when the stimulator is on there is a decrease in spasms. However, during UTI, patient experiences bladder spasms and has less control when the Epidural Stimulation device is switched on. Patient has not seen any changes in neuropathic pain and is still taking the same dose of Nabilone.