Vuk
- Spinal Cord Injury (SCI),
- T12, Complete
Stem Cells, Epidural Stimulation, LamiSpine
- Name:Vuk
- Age at Time of Treatment:26 - 35
- Sex:Male
- Nationality:Serbian
- Treatment Location:Thailand
- Diagnosis on Admission:Spinal Cord Injury (SCI)
- Injury Level:T12, Complete
- Time Since Injury:5 - 15 years
- ASIA Before Treatment:A
- ASIA After Treatment:C
- Treatment Received:Stem Cells, Epidural Stimulation, LamiSpine
- Date of Admission:04/02/2024
- Date of Discharge:20/03/2024
Patient Overview
Patient Condition on Admission
Vuk has suffered from a spinal cord injury at the T12 level since October 2017 after sustaining a fall from 3.5 meters high. His injury resulted in the complete loss of motorand sensory functions below the level of injury. He also suffers from neurogenic bowel and bladder dysfunctions. Vuk went to Dr.Miroslav Zotovic Belgrade’s rehabilitation clinic from November 6, 2017 until October 5, 2018. Then, from
October 10 2018, he continued doing physical therapy in Fizio Vracar, Belgrade. Some medication he used included those targeting nerve and
bladder functions.
Treatment Received
Vuk 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 and device mapping where we were able to see strong muscle contractions. As part of the regenerative medicine treatment, he received LamiSpine treatment which included the direct transplantation of stem cells at the level of injury, one intravenous and one lumbar puncture injections totaling 200 million Mesenchymal Stem Cells.
| Treatment received | Implantation site | Number of devices | Duration of stay |
|---|---|---|---|
| Epidural Stimulation | Lumbar spinal cord | 1 | 46 days |
Stem Cells Treatment Summary
| Stem cells treatment | Number of stem cells | Delivery method |
|---|---|---|
| Mesenchymal Stem Cells (MSCs) | 100 million cells | LamiSpine Injection |
| Mesenchymal Stem Cells (MSCs) | 40 million cells | Intravenous Injection (IV Injection) |
| Mesenchymal Stem Cells (MSCs) | 60 million cells | Lumbar Puncture Injection (LP Injection) |
| Total number of stem cells | 200 million cells |
Device Mapping and Therapy
| Post-surgical care | Total sessions | Sessions per week | Time (Hr.) per session |
|---|---|---|---|
| Mapping | 128 | 20 | 1 |
| Physical therapy | 28 | 5 | 1 |
| Total sessions of rehabilitation | 156 |
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 | 4 |
| Knee flexors | 0 | 4 |
| Ankle dorsiflexors | 0 | 2 |
| Ankle plantarflexors | 0 | 4 |
| 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 rage of motion (ROM) with gravity eliminated / 2+ indicates active movement, less than one half ROM against gravity / 3 indicates active movement, full ROM against gravity / 4 indicates active movement, full ROM against gravity and moderate resistance in a muscle specific position / 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 | Not possible | Possible |
| Stepping with support (for more than 10 meters) | Not possible | Possible |
| Standing Balance | Absent * | Fair * |
| Sitting Balance | Normal * | Good * |
| Motor Coordination (while walking) | Poor * | Good * |
| Sit to Stand | Not applicable (due to bone density) | Not applicable (due to bone density) |
| Ability to transfer | Assistant required | Less assistant required |
| Ability to use abdominal muscles during bowel program | Not possible | No change |
| Stamina & Fatigue | Poor * | Endurance increased |
| Spasticity | Absent | Moderate spasticity (Increased to activate muscle tone) |
Sensory Function
| Abilities & Symptoms | Before ES Surgery | At Discharge (35 days after ES Surgery) |
|---|---|---|
| Neuropathic pain | Absent | No change |
| Temperature sensations | No sensation (below the level of injury) | No change |
| Proprioception | Absent | 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 sweat * | No change |
| Temterature regulation | Normal | Normal |
| Blood pressure regulation | Stable | Stable |
Motor Funtions
89%
Sensory Funtions
0%
Autonomic Function
0%
Overall
53%
Improvements are monitored in 18 targeted areas: 10 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 patient is unable to do a particular activity or function/ ‘Poor’ indicates that patient requires support and moderate to maximal assistance for a particular activity or function/ ‘Fair’ indicates that patient is able to do a particular activity or function with minimal assistance/ ‘Good’ indicates that patient is able to do a particular activity or function and can accept moderate challenge./ ‘Normal’ indicates that patient can do a particular activity or function without any support.
Results Intrepretation
Motor Function
Vuk reported significant improvements in his motor function. He regained hip flexors, extensors, adductors, abductors, knee extensors and flexors as well as movements distally. He was able to stand and walk with support which was not possible before.
Sensory Function
No change in his sensory function at the time of discharge.
Autonomic Function
No change in his autonomic function at the time of discharge. He had stable blood pressure levels at the time of surgery.
Sitting
His sitting function improved significantly at the time of discharge.
Standing
He was able to stand and stay upright for extended periods of time.
Case Summary
Vuk sustained a traumatic spinal cord injury at the T12 level as a result of a fall which rendered him to be paralyzed in his lower limbs. He also lost control of his bowel and bladder functions. He had been receiving standard physiotherapy since the injury which helped him maintain muscle mass and tone. However, there was no recovery of the voluntary motor function in his lower limbs, and he was paralyzed.
After the Epidural Stimulation surgery, Vuk had a break of 2 days and then he started with a comprehensive rehab program. He also received a comprehensive form of stem cell treatment called LamiSpine. After undergoing LamiSpine treatment, the physical therapists assisting Vuk encountered difficulties during the mapping sessions due to frequent changes in the programs tailored for specific activities. Consequently, we offered him to extend his stay by 6 days at no additional cost. Ultimately establishing stable programs to facilitate Vuk’s ongoing therapy upon his return to Serbia.
He reported improvements in his muscle function and control, which slowly but gradually improved to an extent where he was able to walk again. He also reported improvements in his standing ability. He did not report any complications related to the treatment. He was discharged with specific treatment plans to follow in Serbia to continue the recovery process.