Syed
- Spinal Cord Injury (SCI),
- C7, Incomplete
Stem Cells, Epidural Stimulation
- Name:Syed
- Age at Time of Treatment:Under 18
- Sex:Male
- Nationality:Bangladeshi
- Treatment Location:Thailand
- Diagnosis on Admission:Spinal Cord Injury (SCI)
- Injury Level:C7, Incomplete
- Time Since Injury:1 - 2 years
- ASIA Before Treatment:B
- ASIA After Treatment:B
- Treatment Received:Stem Cells, Epidural Stimulation
- Date of Admission:03/04/2025
- Date of Discharge:03/05/2025
Patient Overview
Patient Condition on Admission
Syed suffered a traumatic spinal cord injury at the cervical level, specifically at C7, two years ago. His C7 vertebra sustained a burst fracture, with severe nerve root compression bilaterally at the C6/C7 and C7/T1 levels. He also suffers from bladder and bowel dysfunction.
At the beginning of 2024, Syed went to the Perkeso Rehabilitation Center in Malaysia, where he showed overall improvement. His sitting balance, ability to transition from sitting to standing, and transferring were better. His ASIA score improved from A to B.
Treatment Received
Syed proceeded with the implantation of the Epidural Stimulator at the lumbar spinal cord level. Following the operation, there was a break for 2 days before he started the rehabilitation. As part of the regenerative medicine treatment, he also received one intravenous and two lumbar
puncture injections totaling 100 million Amniotic fluid stem cells.
| Treatment received | Implantation site | Number of devices | Deration of stay |
|---|---|---|---|
| Epidural Stimulation | Lumbar spinal cord | 1 | 35 days |
Stem Cells Treatment Summary
| Stem cells treatment | Number of stem cells | Delivery method |
|---|---|---|
| Amniotic Fluid Stem Cells (AFSCs) | 30 million cells | Intravenous Injection (IV Injection) |
| Amniotic Fluid Stem Cells (AFSCs) | 35 million cells | Lumbar Puncture Injection (LP Injection) |
| Amniotic Fluid Stem Cells (AFSCs) | 35 million cells | Lumbar Puncture Injection (LP Injection) |
| Total number of stem cells | 100 million cells |
Device Mapping and Therapy
| Post-surgical care | Total sessions | Sessions per week | Time (Hr.) per session |
|---|---|---|---|
| Mapping | 90 | 20 | 1 |
| Physical therapy | 25 | 5 | 1 |
| Total sessions of rehabilitation | 115 |
Muscle Power Improvement Post-Surgery
Lower Body
| Muscle improvement | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Hip flexors | 1 | 3 |
| Hip extensors | 1 | 3+ |
| Hip abductors | 0 | 0 |
| Hip adductors | 0 | 0 |
| Knee extensors | 0 | 4 |
| Knee flexors extensors | 0 | 0 |
| Ankle dorsiflexors | 0 | 0 |
| Ankle plantarflexors | 0 | 0 |
| Long toe extensors | 0 | 0 |
Muscle power improvement was assessed according to the Manual Muscle Testing (MMT) protocol on the patient’s discharge date, with the stimulator on. 0 indicates total paralysis, 1 indicates visible contraction, 2 indicates active movement, full range of motion (ROM) with gravity eliminated, 3 indicates active movement, full ROM against gravity, 4 indicates active movement, full ROM against gravity and moderate resistance in a muscle-specific position, and 5 (normal) indicates active movement, full ROM against gravity, and moderate resistance in a muscle-specific position expected from an unimpaired person.
Functional Improvement Post-Surgery
Motor Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Standing with support | Dependent with maximum assistance | Dependent with minimum assistance |
| Stepping with support (for more than 10 meters) | Dependent with maximum assistance (using robot with hoist) | Dependent with minimum assistance (walker) |
| Standing balance | Poor * | Good * |
| Sitting balance | Fair* | Good * |
| Motor coordination (while stepping) | Good * | No change |
| Sit to stand (in a walker) | Moderate assistance | Minimal assistance |
| Ability to transfer | Good | No change |
| Ability to use abdominal muscles during bowel program | No concern | No concern |
| Stamina & Fatigue | Low endurance | Improved |
| Spasticity | Little spasticity | Increased (given program to help) |
Sensory Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Neuropathic pain | No | Developed neuropathic pain (but under medication) |
| Temperature sensations | Impaired | No Change |
| Proprioception | Impaired | No Change |
| Bladder sensation | No sensation | No Change |
| Bowel sensation | No sensation | No Change |
Autonomic Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Sweating ability | No | Developed sweating |
| Temperature regulation | Normal | Normal |
| Blood pressure regulation | Autonomic dysreflexia and orthostatic hypotension | Improved |
Motor Funtions
78%
Sensory Funtions
0%
Autonomic Function
100%
Overall
82%
Improvements are monitored in 18 targeted areas: 9 Motor areas, 5 Sensory areas and 3 autonomic 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. No improvement, the existence of pain or spasms, or an inability to perform a measured function is reported as negative.
*According to the Functional Balance Grades, ‘Absent’ indicates that the patient is unable to perform a particular activity or function. ‘Poor’ indicates that the patient requires support and moderate to maximal assistance for a particular activity or function. ‘Fair’ indicates that the patient is able to perform a particular activity or function with minimal assistance. ‘Good’ indicates that the patient is able to perform a particular activity or function and can accept moderate challenge. ‘Normal’ indicates that the patient can perform a particular activity or function without any support.
Results Intrepretation
Motor Function
There were immediate contractions in his lower limbs as soon as the Epidural Stimulator was turned on. During the 2nd week of hospital stay, Syed started body weight and standing training and ultimately moved on to perform the locomotor training. Towards the end of the treatment, he was able to stand up and walk with upper body support.
Sensory Function
During the treatment there were only minor deep sensations in his body which were expected as this is considered an early phase of recovery.
Autonomic Function
Syed suffered from autonomic dysfunction and postural hypotension. This appeared to have been stabilized during the treatment and his blood pressure levels remained stable.
Sitting
His sitting function showed remarked recovery. He reported improved static and dynamic sitting balance and his overall standing stability improved.
Standing
Syed also showed improvements in his standing stability and balance. He was able to stand with minimal assistance which continued to improve further with training.
Case Summary
Syed sustained a traumatic spinal cord injury at C6-C7 level resulting in weakness in his upper limbs and complete paralysis in his lower limbs. With extensive training in Malaysia, his upper limb functions significantly improved to an extent where he regained partial functions back. However, his lower limbs remained completely paralyzed.
He was evaluated for a potential Epidural spinal cord stimulation surgery, specifically targeting his lower limbs motor function. He went through extensive medical evaluation after which it was concluded that Syed was a suitable candidate for the treatment. He was also recommended to receive stem cell treatment to promote the regeneration of the injured spinal cord and reduce scar tissue.
The surgery went well without side effects and there was a recovery period of 2 days. After that we started mapping lower limb muscles which showed immediate signs of recovery. During the 2nd week of the treatment, we started standing and walking training which continued towards the end of his 35 days stay. At the end we saw significant recovery of his muscle functions to where he was able to stand and walk with upper body support. There were mild changes in his sensory functions, improved standing and sitting balance, and improved autonomic function. Also, due to the level of injury, cervical level, he suffered from postural hypotension which has been stabilized during this time here and his overall blood pressure level reminded stable with no major drops. The overall treatment outcomes were extremely satisfactory, and Syed was discharged with rehab
programs to continue back in Malaysia.