Omental Transpositon to the Chronically Injured Human Spinal Cord:Preliminary Report

Huh, Jae Taeck; Kim, Hyung Dong; Choi, Hyu Jin; Kim, Ki Uk

Abstract

The omentum has been used over the years for a variety of clinical problems. Recently it has shown that placing the omemtum on the brain and spinal cord can lead to an extensive development of vascular connections at the omental/CNS interface. Success with omental transposition to the human brain has led to increasing intreast in placing the omentum onto the human spinal cord. One paraplegic patient was chosen to enter into a feasibility study to see if omental transposition to their spianl cord might result in clinical benefit. The length of time from injury was about 21 months respecively. This patient had little, if any, motor and sensory function below umbilicus level. The operation required surgical lengthening of the pedicled omentum followed by its placement into a subcutaneous tunnel created backward along the lateral chest wall up to T-10, 11 level. An extensive thoracic laminectomy was then performed followed bya wide opening of the dura. In our case the cord showed segmental shrinkage of the spinal cord consistent with previous trauma. The omentum was laid directly onto the underlying spinal cord. Our observation for five months has shown that placement of the omentum onto the chronically injured spinal cord allowed for subsequent improvement in neuroelectrical activity, as manifested by reproducible somatosensory evoked potentials, and, more importantly, in moter function. It is considered that placing the omentum directly upon the brain or spinal cord may have the effect of either improving local vascular perfusion or, possibly, exerting some biochemicals(neurotransmitter), or as yet unknown, influence. But further observation is warranted to determine whether this improvement will be continued and will be observed in another cases.