Neurosurgeon Allan Belzberg, M.D., and orthopaedic trauma surgeon Greg Osgood, M.D., collaborated to offer a novel way to repair the sciatic nerve of a patient — Santi — that was severed in a boating accident, paralyzing his right leg. Santi’s family traveled from Texas to Baltimore so that he could avoid paralysis due to the severe nerve damage. Dr. Osgood applied the principles of bone shortening and, subsequently, lengthening, which allowed Dr. Belzberg to successfully repair the nerve through regeneration.
Mhm Okay, we are going to check on things and see how you did with you. Second go around doctor too far from the plastic surgery service, did a really bang up job. So it's gonna look good, You're gonna be handsome, handsome when you get back on that surfboard. My name is Sandy Pacheco and Back in July 23 I got hit by a boat broke, I was boating with some friends back home in texas and we went to a cliff to jump off. I was swimming back to the boat and I tried to get up on it but a girl reversed it and it sucked me under the proper cup both of my legs and paralyzed my right one. If it wasn't for you know, growing up in water and surfing and swimming, I don't think I would have made it out because I was under for like two minutes. Having your nerve completely severed is not an easy repair um has to be a magical repair. And so at that point we were hunting nonstop for someone that had peripheral nerve damage repair experience. So Santi came up to Hopkins, we got him in the hospital, how to look at things and in talking with him and his parents, we said let's reopen the wound and look at the nerve, see how badly damaged it really is and whether there's any way to repair the nerve. We're talking about the main nerve that goes down the back of your leg. The sciatic nerve and that controls all the function of the ankle that moves your ankle up and down and provides sensation to the foot. So it's a very critical structure in your body. It had been very, very badly injured. Not only was it separated in two had been sliced through and badly traumatized and where the injury was, which is very high up in the thigh. I knew that the chance of putting in cable graphs, we call them and having sufficient time for it to regenerate back down the leg. The likelihood that that would give him any function was extremely small. And we became very pessimistic that we could do anything useful for this young man. We really stepped back and said, is there anything else we can do? Is there any other concept here that we can try to get this nerve to come back together right in a lot of what I do in trauma and taking care of fractures that don't heal or fractures that heal incorrectly. I am often shortening or lengthening a bone uh and using the principles of bone healing to our advantage. And I said, yeah and I think we can probably Remove about seven cm of bone in this young healthy kids and with a good result lengthen him out over time, would that help to do a primary nerve repair and get him function? That's a concept that's been tried elsewhere in the body, not to my knowledge, has it ever been done in the leg. So we thought plausible and I went out and talked to his parents during the surgery and we had a long discussion. Taking out a nice big healthy piece of bone. Is it gives you a bit of pause saying we have to be making sure we're doing the right thing. And then we put a rod in it and we took the nail and we squeezed the fracture and we shortened his leg by 7cm. And then I was able to repair the nerve. Bring the two ends together under the microscope so that together and having what we call an end to end repair without any tension on the nerve. That's the best possible situation for regeneration. Still a long shot in the sense that the injury is very high up in his thigh and it's going to require a long time for the nerve to regenerate and repair all the way down to his calf. We were very pleased with the result of the operation itself. Unfortunately, then we had to have the waiting game to see what would happen over time. Okay, a few words here. Mr. On your first day, I don't know you're getting some vitamin D. Sanely son. I was bedridden for like two months and then slowly taking a few steps and got to the point where I was good enough to go home. Yeah. Okay. First time walk. Nice. Mhm. The next step in that procedure was to bring him back several months later after giving enough time for the tissues to heal. And then we put in a rod that grows over time with stimulus from outside using magnets and motors. The nerve had already healed back together. Now we're hoping that the nerve will stretch as his leg stretches and will regrow. And that was also a big question. Whether that would happen or not. Mm hmm. So, I'm almost seeing them. How? Almost not even argument. We'll show you the X rays look grossly spot when we've been following him over time. What we look for is is he showing us signs that those axons are regrowing? They're very, very sensitive. You tap on them. You get like hitting your funny bone. You get this electric discharge of the nerve. And it's like, whoa! It's like I hit my funny bone. Get back here. Oh my God, that's really good. All right, go go. Oh, it was very exciting because I was I didn't know if I had trusted him for that tapping, but when I tapped myself and measured it out, he was regenerating very quickly that 10 months into this is unbelievable. That is much much faster that anyone would anticipate. And I'm going to have to go back to my laboratory and study this to understand how that happened so quickly. I knew that he had reported some of these things. I think things are better than you expect. But to see it in person just gets you choked up. It gets you really happy for him when I'm faced with a problem like Santy there's no one doctor, one surgeon that can deal with all of the different issues because it really does require different specialties to deal with this. We work together to come up with innovative plans to say we can think outside the box, we can do something different and I think we can get them better and I don't think you can find in many places. I got to tell you that one of the biggest steps in his recovery was the lengthening process and to be able to have him complete or almost completed. We're very, very excited. My end goal with all of this is to get back in the water and be able to surf again. I've been practicing pop ups on the floor in my room and I just really want independence and just see that I made it out fully and really feel good with my day to day. Okay. It's so rewarding to be able to work with patients and their families when you can offer them something that impacts their life while it's wonderful for them. I gotta tell you it's equally wonderful for us to be able to do that. The excitement, the thrill of seeing him back on that board. It is just amazing to me. It's it's wonderful. Mhm. Mhm. Yeah
Related Presenters
