Tylan
- Spinal Cord Injury (SCI),
- T6, Complete
Stem Cells, Epidural Stimulation, LamiSpine
- Name:Tylan
- Age at Time of Treatment:36 - 45
- Sex:Male
- Nationality:South African
- Treatment Location:Thailand
- Diagnosis on Admission:Spinal Cord Injury (SCI)
- Injury Level:T6, Complete
- Time Since Injury:1 - 2 years
- ASIA Before Treatment:A
- ASIA After Treatment:C
- Treatment Received:Stem Cells, Epidural Stimulation, LamiSpine
- Date of Admission:12/09/2024
- Date of Discharge:21/10/2024
Patient Overview
Patient Condition on Admission
Tylan sustained a traumatic spinal cord injury in the beginning of 2023 at the thoracic level, rendering him paralyzed below the level of injury. He has a complete loss of motor and sensory functions from his chest downwards. Tylan used to do physical therapy, where he mainly focused on his upper limb exercises by himself at a gym in Dubai. He then moved to South Africa for 8 weeks of intensive rehabilitation before
coming to Thailand.
Treatment Received
Tylan proceeded with the implantation of the Epidural Stimulator at the lumbar spinal cord. In addition to the ES implantation, he also received Verita Neuro’s proprietary LamiSpine treatment combined with one intravenous and one lumbar puncture injections. Following the operation, there was an observation period of 2 days before he started the
rehabilitation and device mappings
where we were able to see strong muscle
contraction.
| Treatment received | Implantation site | Number of devices | Duration 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 (AFSC) | 75 million cells | Intraspinal injection |
| Mesenchymal Stem Cells (MSCs) | 40 million cells | Intravenous injection (IV injection) |
| Mesenchymal Stem Cells (MSCs) | 35 million cells | Lumbar puncture injection (LP injection) |
| Total Number of Stem Cells | 150 million cells |
Device Mapping and Therapy
| Post-surgical care | Total sessions | Session per week | Time (Hr.) per session |
|---|---|---|---|
| Mapping | 110 | 20 | 1 |
| Physical therapy | 30 | 5 | 1 |
| Total sessions of rehabilitation | 140 |
Muscle Power Improvement Post-Surgery
Lower Body
| Muscle improvement | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Hip flexors | 0 | 2+ |
| Hip extensors | 0 | 2+ |
| Hip abductors | 0 | 2 |
| Hip adductors | 0 | 2- |
| Knee extensors | 0 | 1 |
| Knee flexors | 0 | 1 |
| 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 | Unable | Able (with walker) |
| Stepping with support (for more than 10 meters) | Unable | Able ( with walking frame) |
| Standing Balance | Unable | Able |
| Sitting Balance | Able (with support) | No change |
| Motor Coordination (while Stepping) | Unable | Able |
| Sit to Stand (in a walker) | Unable | Able (with moderate support) |
| Ability to transfer | Able (with transfer board) | Able (without support) |
| Ability to use abdominal muscles during bowel program | Unable | Able (using abdominal muscles) |
| Stamina & Fatigue | Low endurance | Increased endurance |
| Spasticity | Minimal - moderate | Increased |
Sensory Function
| Abilities & Symptoms | Before ES Surgery | At Discharge (35 days after ES Surgery) |
|---|---|---|
| Neuropathic Pain | Absent | No change |
| Temperature Sensations | Absent | No change |
| Proprioception | Absent | No change |
| Bladder Sensation | Absent | No change |
| Bowel Sensation | Absent | No change |
Autonomic Function
| Abilities & Symptoms | Before ES Surgery | At Discharge (35 days after ES Surgery) |
|---|---|---|
| Sweating Ability | One-side Sweating | Improved |
| Temperature Regulation | Normal | Normal |
| Blood Pressure Regulation | Normal | Normal |
Motor Funtions
80%
Sensory Funtions
0%
Autonomic Function
100%
Overall
56%
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
Tylan’s motor functions began to recover as soon as the stimulation started. His muscle function in all major muscle groups improved. His legs started to recover, and he regained control over their movements. Ultimately, he was able to stand, lock his knees, and walk with support.
Sensory Function
Tylan started to report pins and needles, a more burning-like sensations indicating the onset of his sensations coming back.
Autonomic Function
Since Tylan already had stabilized blood pressure levels, there was no change in this part. His bladder started to have more contractions visible in the form of urinary urgency, also an early indication of potential recovery in his bladder.
Sitting
Tylan had better sitting balance. His lower abdominal and paraspinal muscles were stimulated using the ES. Both static and dynamic sitting balance improved.
Standing
Tylan had a better postural stability while standing. He was able to maintain and hold himself during the standing position, lock his knees and remain upright.
Case Summary
Tylan sustained a traumatic spinal cord injury at thoracic level in 2023 and received Epidural Spinal Cord stimulation and LamiSpine surgery in order to improve the motor function and promote the regeneration of the spinal cord tissue. Verita Neuro’s flagship LamiSpine surgery involves the transplantation of the purified and cultured amniotic fluid stem cells into the injured spinal cord. Additionally, he also he received one intravenous and one lumbar puncture injection of stem cells.
The surgery and post-operative course went well without complications and Tylan was ableto start the mapping and rehab 2 days later. Once the stimulator was turned on, there was an immediate recovery of targeted muscles. Over time his motor control became progressively better to an extent where Tylan was able to stand, lock his knees, remain upright and walk with upper body support. He also reported mild improvements in sensations during the treatment and had early signs of his bladder recovery. Overall, the treatment and the outcomes were very satisfactory.