Spinal cord repair with acidic fibroblast growth factor as a treatment for a patient with chronic paraplegia

Study Design. We present a case of a patient with chronic paraplegia with a complete spinal cord gap resulting from a stabbing injury 4 years ago recovering after an innovative surgical strategy. Objectives. To demonstrate the clinical outcome of surgical repair with sural nerve graft with fibrin glue containing acidic fibroblast growth factor in a patient with chronic spinal cord injury. Summary of Background Data. Spinal cord injury usually causes permanent disability, and there had been not effective surgical technique to obtain satisfactory functional motor recovery, particularly in chronic patients. Previous studies have revealed that acidic fibroblast growth factor could promote axonal regeneration and reduce neuronal death in adult rats with spinal cord injury. Methods. The spinal cord gap at T11 level was bridged with 4 sural nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin glue containing acidic fibroblast growth factor. Results. Before the operation, the paraplegia was identified as ASIA-C, with a motor score for the right and left legs of 12 and 0, respectively, a pinprick score of 77, and 77 on a light touch of left side limbs. His functional status improved from being wheelchair-bound to being able to ambulate independently with a walker 2-and-a-half years after surgery. At this stage, paraplegia was ASIA-D, with motor scores for the right and left legs of 15 and 12, respectively, 86 for a pinprick, and 86 for a light touch of left side limbs. Conclusions. This case demonstrated significant motor recovery attained in a patient with chronic paraplegia following a repair surgery with nerve graft and growth factor.