Advancements or their components to produce useful usually commercial

Advancements in Spinal Growth Repair, Specifically in Syringomyelia 

Francesca Pasqua

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January 26, 2018

Table of Contents

What is Biotechnology?…………………………………………………………………Page 1
Biotechnology in the Field of Medicine………………………………..………………Page 2
What is Syringomyelia? …………………………………………………………..……Page 4
How Does Syringomyelia Occur?………………………………………………………Page 5
Symptoms of Syringomyelia……………………………………………………………Page 6
Treatments for Syringomyelia ……………………………………………………….…Page 8
Real Life Case: Sonia Pasqua……………………………………… …………………Page 11
What Are Stem Cells?………………………………………………………………….Page 12
Studies Offer New Hope for Diagnosis of Chiari-Malformation in Toy Dog Breeds…….Page 14
Study Using Human Fetal Tissue Transplants Suggests Potential For Spinal Cord Repair……Page 16
Stem cell therapy enables spinal regrowth…………………………………………….Page 18
Using donor stem cells to treat spinal cord injury……………………………………..Page 20
Paralyzed man walks again after nose cells repair his spinal cord…………………….Page 22
References……………………………………………………………………………Page 26

What is biotechnology?

Merriam-Webster defines biotechnology as “the manipulation (as through genetic engineering) of living organisms or their components to produce useful usually commercial products (as pest resistant crops, new bacterial strains, or novel pharmaceuticals).” (**reference dictionary) Throughout the years, the advancements of science and technology have been astounding. Through innovative technology, humanity has been able to explore every organism between the depths of the ocean to the planets in our solar system. Biotechnology is the use of technology and living organisms in order to aid in advancements of scientific research.
Presently, the field of biotechnology envelopes a wide range of disciplines. Every year, new creative and innovative machines and products are created. The fields that biotechnology is predominantly present in are the fields of medicine, agriculture, forensic, and industrial biotechnology.
Syringomyelia is one of many conditions that has been greatly affected because of the advancements of biotechnology. Syringomyelia is a rare condition that,  due to medical advancements, now has multiple procedures that aid in fixing the condition. Years ago, there was no cure or medical procedure that could relieve patients of their condition and they were left struggling to cope with the pain that was brought on by syringomyelia. Today, patients are able to be treated through pain numbing medication and medical procedures that could possibly fix their condition.

Biotechnology in the Field of Medicine 
Through advancements in biotechnology, modern medical devices have been made easily available for diagnostic and preventive purposes. This includes diagnostic test kits, vaccines and radio-labeled biological therapeutics designed for imaging and analysis. One of the worlds greatest concerns is human health worldwide because of infectious diseases. 
Biotechnology has played a critical role in enhancing the challenges regarding human health as it has the potential to diminish global health differences. Health, life quality and expectancy of life have been increased worldwide through the services provided by biotechnology. Malnutrition mainly arises due to the lack of essential nutrients and vitamins in food and ultimately results in death. Biotechnology has play a major role in eliminating these problems by producing nutrients enriched food such as Golden Rice, Maize, potato and soybean etc. Biotechnology has also played an important role in controlling the environmental pollution through biodegradation of potential pollutants. This review sketches improvement of human health by the use of biotechnological advances in molecular diagnostics, medicine, vaccines, nutritionally enriched genetically modified  crops and waste management. (Afzal, H., Zahid, K., Ali, Q., Sarwar, K., Shakoor, S., Nasir, U., & Nasir, I. A., 2016)

What is Syringomyelia?
       “Syringomyelia is a rare disorder in which a cyst forms within your spinal cord. As this fluid 
filled cyst, or syrinx, expands and lengthens over time, it compresses and damages part of your 
spinal cord from its center outward.” (Nguyen, B. 2017, p 1).
Syringomyelia is a disease in which a cyst known as a syrinx forms within the spinal cord. The location, size, and length of the syrinx can vary between patients. The most common way for a patient to be diagnosed with syringomyelia is through an MRI of the brain and spine. (Krause, L. 2017) 
Syringomyelia is a condition where a cavity that is filled with fluid or a syrinx (cyst) forms inside the spinal cord (refer to figure**). It is a chronic condition where the syrinx can grow over time. This will result in the  compression or destruction of the surrounding nerve tissue. (Tubbs, S. 2017)

How Does Syringomyelia Occur? 
In many cases, the cause of syringomyelia is Chiari type 1 malformation (CM1), a malformation of the brain. The location at which the brain joins the spinal cord is where CM1 occurs (refer to figure **). The cerebellum is located at the back of the brainstem. In most cases of CM1, the bases of the lobes of the cerebellum, or the cerebellar tonsils, protrude from the skull and into the spinal canal. The brainstem lies lower than normal due to this malformation. Syringomyelia can form due to a great deal of complications such as trauma, meningitis, hemorrhage, a tumor, and arachnoiditis. (Nguyen, B. 2017)
There has yet to be a discovery of a conclusive reason for the formations of syrinx. The most common hypothesis of the formation of a syrinx is that the flow of the cerebrospinal fluid has been disturbed or blocked. This fluid is located in and around the brain as well as around the spinal cord. One of its most important functions is to cushion and protect the brain which allows for buoyancy.(Tubbs, S. 2017)
Other causes of syringomyelia, as discussed by Krause are trauma, infection such as meningitis, hemorrhage, Chiari I malformation, myelomeningocele, spina bifida, and tethered cord. Spinal tumors can also cause cysts to form inside the spinal cord. (Tubbs, S. 2017)

Symptoms of Syringomyelia
The pressure that is applied to the spinal cord by the syrinx causes the symptoms of syringomyelia. Some symptoms may include:
• a progressive weakness and pain in the back, shoulders, arms, or legs
• an inability to feel hot or cold
• a loss of pain sensation
• difficulty walking
• bowel and bladder function problems
• facial pain and numbness
• curvature of the spine, or scoliosis (Nguyen, B. 2017)
The degree of pain felt by patients of syringomyelia varies between each patient. The degree of pain can range from moderate to severe. There can be many symptoms present due to the damaging of the spinal cord and spinal nerves. (Krause, L. 2017)
Syringomyelia is typically slowly progressive, but it is possible for rapid onset to occur. The most common symptoms include pain in the neck and shoulders, as well a muscle weakness. Pain described as a burning, tingling or piercing sensation may also affect the arms and hands. Some individuals who are affected may also experience numbness or decreased sensation, especially to tenperature. The upper (cervical and thoracic)  portions of the spinal cord are most often affected in syringomyelia (refer to figure**). Typically, the first symptom is a loss of feeling for pain and temperature in their fingers, hands, arms, and upper chest. A sense of touch is still present in the early stages. This loss of feeling may continue to spread over the shoulders and back.
Pain and stiffness in the legs can also occur. Individuals may experience uncoordinated movements in their legs, which could possibly affect the ability to walk. Paralysis of the arms or legs can occur in sever cases. Small muscles contractions, such as “twitches”, may also be experienced by individuals.
Another symptom includes skeletal abnormalities such as scoliosis. As there is damage to the nerves that supply joints, chronic, progressive degeneration may occur. Charcot joints are initially seen as swelling and redness of the affected areas. Without treatment, deformity of the affected joints can occur.
Other symptoms may be associated with damage to the autonomic nervous system. This would include loss of control over ones bowel and bladder, an excessive amount of sweating, and inconsistent blood pressure levels. (Tubbs, S. 2017).
Treatments for Syringomyelia
Syringomyelia is a disorder in which there are no medication or treatments. Therefore, performing surgery is the only viable option, as of right now, in which Syringomyelia can be corrected.
Posterior Fossa Craniotomy/Craniectomy
The Posterior Fossa is a sub-occipital bone. This operation involves the removal of the bone from the back of the Posterior Fossa. The Dura Mater is an outer covering of the brain which must also be opened and expanded. This is done by suturing a “dural graft” in place. The result of this procedure This combined procedure results in the establishment of much more room for the Brain, Brain Stem and the Spinal Cord. A critical portion of this operation involves microsurgically dividing the tense arachnoid bands that hold the Cerebellar Tonsils to the inside of the Dura Mater and to the Medulla.
Shunt Procedure
An alternative treatment involves the insertion of a tiny (1 millimetre diameter) Silastic tube (a shunt) into the Syringomyelia cavity. The operation consists of Laminectomy (removal of  the Lamina – the roof of the Spinal Column) at the particular Spinal level overlying the Syrinx. After opening the Dura Mater, a tiny opening is made in the back of the Spinal Cord in order to insert the tube into the Syringomyelia cavity. The tube is fixed in place with a very fine non-absorbable (permanent) suture and serves to reroute the Cerebrospinal Fluid from within the Spinal Cord (refer to figure**). A successful surgery will, hopefully, stabilize the condition and perhaps gain a modest improvement in symptoms. Unfortunately this operation requires opening the Spinal Cord over a miniscule segment which nevertheless, destroys that tiny portion of the Spinal Cord where the opening is made. In our experience, this invariably results in some sensory impairment and/or dysaesthesia (disagreeable altered sensation) since the area of the back of the Spinal Cord is a “sensory tract”. Historically, over time, this surgery is not always successful and multiple surgeries may be necessary.  

Terminal Ventriculostomy
The “Terminal Ventricle” is a peculiar anatomical structure that becomes apparent in some patients with Syringomyelia. The Central Canal of the Spinal Cord may be dilated at the end of the Spinal Cord. In these patients, it is possible to open into that “Ventricle” to place a tiny Silastic tube (similar to the one described above). This results in a “venting” or indirect decompression of the Syrinx which is connected to the Terminal Ventricle through the Spinal Cord’s Central Canal. This operation can be accomplished using Minimally Invasive technique through a Thoraco-lumbar junction Laminectomy. It, as well, requires opening through “normal” Spinal Cord which means risking some neurological function. In this case the very end of the Spinal Cord may not place the patient at much risk. The actual risk depends on the precise location of this Terminal Ventricle. (Lazar, M. L. 2017)

Real Life Case: Sonia Pasqua
Below, is an interview that was conducted with Sonia Pasqua and how she has dealt with having Syringomyelia.
How did you find out you had syringomyelia?
“One day at work the left side of my face went totally numb so I went to the hospital and they did some neurological tests that came back as abnormal.  They sent me to a neurologist who did further tests and also concluded that my reflexes on the left side of my body were abnormal.  I then went for an MRI and that’s when they discovered the syrinx.”
Describe what its like to have syringomyelia.
“My whole life I have had problems with the left side of my body.  Numbness, weakness and pain on my left shoulder and arm.  When the Syrinx presses on the nerves the pain is excruciating. I am still able to go about my normal daily activities, except that I am dealing with constant pain when that happens, when the pain subsides I only have to deal with the numbness which has become part of my life now.”
How has living with this condition affected your day to day life?
“When the syrinx shifts and presses on my nerves, there is a lot of pain, I have a hard time sitting or lying down.  The pain is constant until the pressure on my nerves is released. Pain medication doesn’t help, I just need to deal it with until the syrinx shifts again.”
Have you ever been treated for your condition?
“Not treated just monitored.”
How have you had to adapt to living with your condition?
“My condition is not debilitating, I have just learned to cope with the numbness and pain when the syrinx shifts and presses on my nerves.”

What Are Stem Cells? 
“Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. 
Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions,  they can be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.
Stem cells are important for living organisms for many reasons. In the 3- to 5-day-old embryo, called a blastocyst, the inner cells give rise to the entire body of the organism, including all of the many specialized cell types and organs such as the heart, lungs, skin, sperm, eggs and other tissues. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease.
Given their unique regenerative abilities, stem cells offer new potentials for treating diseases such as diabetes, and heart disease.” (NIH Stem Cell Information Home Page. In Stem Cell Information World Wide Web site. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2016 cited January 6, 2018 Available at )