Zehan Liu1, Shuai Ren1, Kuang Fu2, Qiong Wu2, Jun Wu3, Liting Hou4, Hong Pan4, Linlin Sun5, Jian Zhang1, Bingjian Wang1, Qing Miao1, Guiyin Sun1, Vincenzo Bonicalzi6, Sergio Canavero6, Xiaoping Ren7. 1. Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China; State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Nangang District, Harbin, China; Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China. 2. Department of MR Diagnosis, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China. 3. Department of Neurology, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China. 4. Department of Anesthesia, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China. 5. Department of Pharmacology, Harbin Medical University, Nangang District, Harbin, China. 6. HEAVEN/GEMINI International Collaborative Group, Turin, Italy. 7. Hand and Microsurgery Center, the Second Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, China; State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Nangang District, Harbin, China; Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China; Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA. Electronic address: chinarenxg@126.com.
Abstract
BACKGROUND: Cephalosomatic anastomosis or what has been called a "head transplantation" requires full reconnection of the respective transected ends of the spinal cords. The GEMINI spinal cord fusion protocol has been developed for this reason. Here, we report the first randomized, controlled study of the GEMINI protocol in large animals. METHODS: We conducted a randomized, controlled study of a complete transection of the spinal cord at the level of T10 in dogs at Harbin Medical University, Harbin, China. These dogs were followed for up to 8 weeks postoperatively by assessments of recovery of motor function, somato-sensory evoked potentials, and diffusion tensor imaging using magnetic resonance imaging. RESULTS: A total of 12 dogs were subjected to operative exposure of the dorsal aspect of the spinal cord after laminectomy and longitudinal durotomy followed by a very sharp, controlled, full-thickness, complete transection of the spinal cord at T10. The fusogen, polyethylene glycol, was applied topically to the site of the spinal cord transection in 7 of 12 dogs; 0.9% NaCl saline was applied to the site of transection in the remaining 5 control dogs. Dogs were selected randomly to receive polyethylene glycol or saline. All polyethylene glycol-treated dogs reacquired a substantial amount of motor function versus none in controls over these first 2 months as assessed on the 20-point (0-19), canine, Basso-Beattie-Bresnahan rating scale (P<.006). Somatosensory evoked potentials confirmed restoration of electrical conduction cranially across the site of spinal cord transection which improved over time. Diffusion tensor imaging, a magnetic resonance permutation that assesses the integrity of nerve fibers and cells, showed restitution of the transected spinal cord with polyethylene glycol treatment (at-injury level difference: P<.02). CONCLUSION: A sharply and fully transected spinal cord at the level of T10 can be reconstructed with restoration of many aspects of electrical continuity in large animals following the GEMINI spinal cord fusion protocol, with objective evidence of motor recovery and of electrical continuity across the site of transection, opening the way to the first cephalosomatic anastomosis. (Surgery 2017;160:XXX-XXX.).
BACKGROUND:Cephalosomatic anastomosis or what has been called a "head transplantation" requires full reconnection of the respective transected ends of the spinal cords. The GEMINI spinal cord fusion protocol has been developed for this reason. Here, we report the first randomized, controlled study of the GEMINI protocol in large animals. METHODS: We conducted a randomized, controlled study of a complete transection of the spinal cord at the level of T10 in dogs at Harbin Medical University, Harbin, China. These dogs were followed for up to 8 weeks postoperatively by assessments of recovery of motor function, somato-sensory evoked potentials, and diffusion tensor imaging using magnetic resonance imaging. RESULTS: A total of 12 dogs were subjected to operative exposure of the dorsal aspect of the spinal cord after laminectomy and longitudinal durotomy followed by a very sharp, controlled, full-thickness, complete transection of the spinal cord at T10. The fusogen, polyethylene glycol, was applied topically to the site of the spinal cord transection in 7 of 12 dogs; 0.9% NaCl saline was applied to the site of transection in the remaining 5 control dogs. Dogs were selected randomly to receive polyethylene glycol or saline. All polyethylene glycol-treated dogs reacquired a substantial amount of motor function versus none in controls over these first 2 months as assessed on the 20-point (0-19), canine, Basso-Beattie-Bresnahan rating scale (P<.006). Somatosensory evoked potentials confirmed restoration of electrical conduction cranially across the site of spinal cord transection which improved over time. Diffusion tensor imaging, a magnetic resonance permutation that assesses the integrity of nerve fibers and cells, showed restitution of the transected spinal cord with polyethylene glycol treatment (at-injury level difference: P<.02). CONCLUSION: A sharply and fully transected spinal cord at the level of T10 can be reconstructed with restoration of many aspects of electrical continuity in large animals following the GEMINI spinal cord fusion protocol, with objective evidence of motor recovery and of electrical continuity across the site of transection, opening the way to the first cephalosomatic anastomosis. (Surgery 2017;160:XXX-XXX.).