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Radical Nerve Operation Gives Hope To Paraplegics

BERLIN (dpa) – When Angelo Colombo, a painter and amateur boxer, fell off a roof and broke his spine in 1995, doctors told him he would never walk again.

Then Colombo came into contact with Italian neurosurgeon Giorgio Brunelli, whose radical methods have enabled him to walk, if only for 50 or 60 paces, and drive a car. He needs supports and will never walk properly again, but the success of the procedure surprised participants at the recent World Spinal Column congress in Berlin.

Brunelli, 75, who operated at the Clinica Ortopedica at Brescia University and is now in semi-retirement in Imola, had published little about the case.

Fellow surgeons called the operating technique “unique and sensational”. Brunelli had been the first in the world to try the operation and achieve initial success, they said.

To date the medical profession has held that once the spinal column is broken, paralysis cannot be reversed.

Brunelli took the arm nerve on each side that controls the fourth and little fingers and diverted it under the skin from the shoulders to one of the major nerves in the hips.

Colombo struggled at first. “When he wanted to move his hand his leg twitched, but through intensive training he learned to concentrate on his hand when he wanted to walk,” Brunelli said.

He has carried out the operation four times, although the other patients have not as yet had as much success as Colombo.

Recently Brunelli tried yet another method. He removed a long thigh nerve from a young woman on both sides of her body and created a link between the last intact vertebra and the three most important thigh nerves.

The nerve endings were joined in the 12-hour operation using standard microsurgery methods.

Restoring the spinal cord after a total rupture remains one of the greatest challenges facing modern medicine. Nerve cells are able to regenerate to some extent, but never by more than a millimetre, according to Martin Schwab of Zurich University’s brain research institute.

Using special growth preparations it has been possible to increase the length of nerve regenerated to several centimetres in cell cultures and in rats. The rats learn to move again, even if uncertainly.

“The similarity between the biologies of rats and people with regard to nerve growth gives rise to hope that these results could lead to new treatments for paraplegics and those with brain damage in the not too distant future,”
Schwab believes.

Brunelli is using different methods to achieve much the same goal with his rerouting or transplantation of nerve fibre clusters up to 45 centimetres long. He acknowledges that the healing process after his operations is a long one.

The functional part of the nerve grows from the point of damage by around only one millimetre a day, and for this reason it takes at least 18 months for the connection to be complete and an instruction from the brain to arrive at its destination.

Other methods are also under consideration. French doctors were able at the beginning of the year to enable a paraplegic to stand and walk to some extent by means of an implanted microchip.

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