Treatment Techniques

We choose different treatment techniques according to patients’ different conditions and diseases. At present, we mainly use lumbar puncture, CT-guided intranspinal injection, interventional therapy, intravenous injection and stereotactic brain surgery.

Lumbar Puncture

Lumbar puncture is a therapeutic procedure which is conducted under local anesthesia. The whole procedure usually lasts for 15 minutes.

During the procedure, a needle will be inserted into the spinal canal between two lumbar vertebrae. This careful insertion would almost lead no harm to the body as the spinal cord is absent in this location. After tapping cerebral spinal fluid (CSF), the surgeon will inject stem cells into the subarachnoid space. Then the natural CSF circulation would lead stem cells to travel into the spinal cord and brain. It would take about six hours for one cycle of CSF circulation.

Patients need to stay on their beds for six hours for monitoring after receiving the transplantation via lumbar puncture. Most patients have no side-effect after the surgery, although they may experience headache or backache. The pain is temporary and expected to disappear within a few days.

This procedure is simple, safe, and pain free. It can direct a large quantity of stem cells into the central nervous system.

Notice Before Treatment

1) If the morning surgery, the amount of breakfast is halved, try to eat solid food and less than normal days.

2) wear clothes and trousers that are easy to expose the waist, otherwise the surgery will be affected.

3) Patients with a history of epilepsy should be prepared to suck in oxygen in the ward and the tongue depressor bundled with gauze.

4) Sign the Acknowledgement and Operation Consent Form before surgery.

5) Disinfection work half an hour before the operation in the ward.

After Treatment

1)After the operation,  keep laying down for 6 hours without pillow .

2)After 6 hours, patient could eat and drink  as usual but  avoid intense activities.

3)Postoperative routine examination: heart rate, blood pressure, body temperature whether the patient has fever, vomiting and other adverse reactions during lying down.

4) Do not take a bath within 3 days after surgery, keep the surgical site dry to avoid infection.

CT-guided Intranspinal Injection

CT-guided intraspinal injection used in the stem cell treatment for spinal cord injury has been developed by Dr. Cheng’s medical team. The procedure causes no trauma to the patient, avoids loss of blood and pain, and allows for rapid recovery. A main advantage is that no major surgery is required. The surgeon operates with sophisticated knowledge of neural anatomy making use of high-level technology.

There will be no trauma caused during the procedure, least pain and loss of blood, and patients could recover rapidly. One of the biggest advantages of this surgery is that no major surgery is required.

Another advantage of the procedure is that it not only allows ordinary visual control but also employs modern imaging technology so the surgeon can inject a large quantity of stem cells directly into the spinal cord with great accuracy. The procedure is conducted with a 64-slice CT under either local or general anesthesia.

With the help of markers, the CT measures the exact area of the injury. It provides a 3D image of the spine that can be rotated in space to check the position of the fractured vertebrae. A 1-1 needle is inserted into the healthy area where the bones do not obstruct the path of the needle. As the surgeon inserts the needle, and until it reaches the spinal cord, updated images are created to check the angle of the needle. The spatial relationship between the spinal cord and vertebrae can be identified exactly, ensuring a safe injection.

Following the injection, the patient remains in the observation room overnight for monitoring. The CT-guided intraspinal injection is also supplemented by a lumbar puncture and/or IV injection of stem cells.

Side effects of CT guided intraspinal injection

Many patients experience post-surgical pain such as radiating pain in the back and extremities, which is expected and natural. This pain is expected to disappear within approximately three days.

Post Treatment Monitoring

After procedure patients are observed and put on a monitor which assesses their heart rate, res­piration, and other relevant information. A nurse will tend to you, gauge your temperature, and record all data. If you don’t have fever or complications, you will be free to leave the hospital. The hospital is accessible 24 hours a day, seven days a week, and will be ready to treat you in the event of any unexpected medical complication.

Interventional Therapy

The interventional therapy is a 90 minutes procedure performed in local anesthesia. This procedure could guide a large quantity of stem cells into the target area.

In the beginning of the procedure, the area of catheterization needs to be sterilized. Then the doctor will apply local anesthetics.

A needle will be passed into the main artery, and a guide wire will be inserted through this needle. Then the needle will be removed. The catheter is guided exactly to the target area.

In order to show the area on the CT images, a radio-opaque contrast material will be injected into the blood vessel through this catheter. When absorbing the x-rays, the contrast agent will become visible, and then the inside of blood vessels is visualized for doctors to check if the catheter has reached the pancreatic artery as planned.

Stem cells are injected as long as the position is confirmed by angiogram.

At last, the catheter will be removed, and the patient needs to be observed for overnight.

Possible risks and complications

It is very rare for patients to have major complications after this interventional therapy. However, it is possible to have side-effects as bleeding, bruising at the puncture side, blood vessel damage, and allergic reaction to the contrast material.

Intravenous Injection

As for intravenous injections, doctors will blend stem cells into physiological saline and inject it into the blood stream. Then stem cells will travel throughout the body and reach the injured tissues. As the concentration of cells which finally arriving at the target organ is relatively low, this kind of transplantation is usually used as a ministrant method.

Stereotactic Brain Surgery

Stereotactic brain surgery is usually used for elder patients.

Before the surgery, patients need to receive a thorough check-up and laboratory tests. After confirming the eligibility for treatment, they can receive the surgery with general anesthesia.

At the beginning of the surgery, a surgical frame will be fixed at four points on the patient’s skull. The CT scans will coordinate with the frame on the head to locate the exact position of the target area. An auxiliary frame will be connected to the surgical frame in the operating room, for the purpose of fixing the head in position.

There are small holes (about 0.8 cm size) created by the neurosurgeons at two points in the skull, and two needles can be inserted into the target area through the holes. Neurosurgeons will then deliver a maximum concentration of stem cells to the exact position of the target area. The wound will be closed after the procedure.

Eligibility

Not every one is eligible for this procedure; this surgery is recommended only when fine motor skills need to be improved, and particularly for adult patients since their regenerative ability is slower. Patients with high spasticity and have no or slight mental impairment can receive this procedure as well. But stroke patients or patients with severe epilepsy are ineligible for this surgery.

Duration

An entire day is required for the whole procedure. In fact, the surgery itself only takes less than an hour. But procedures such as inserting the frame, taking CT scans and injecting anesthesia cost a lot of time. Relatives or guides can only stay with the patients before he or she receives anesthesia, and they can meet the patient later during observation. Normally patients leave operation room in the late afternoon. Then they are taken to the observation room and monitored for a day. After that, they can leave the room if no complications occur. Patients can eat or walk the next day, but they need to avoid wetting their head for a few days. Nurses will help patients to change bandages regularly, and the staples will be removed after a week.