Autograft-derived spinal cord mass in the cervical spine following transplantation with olfactory mucosa cells for traumatic spinal cord injury: case report

Abstract

This study describes a patient with an autograft-derived spinal cord mass following transplantation of olfactory mucosa for treatment of cervical spine injury. The authors report the case of a 35-year-old man who suffered a complete spinal cord injury (SCI) at C5–6 in 2001. The patient underwent an olfactory mucosal cell implantation at the location of injury 4 years following initial trauma. Twelve years later, the patient presented with rapidly progressive decline in upper-extremity function as well as neuropathic pain. Imaging revealed a heterogeneously enhancing intramedullary mass from C3 to C7. At surgery, the patient was found to have a posttransplant mucinous mass. Each mucinous cyst was drained and a portion of the cyst wall was removed. Histological examination demonstrated ciliated epithelium-lined fibrous tissue, submucosal glands, and mucoid material, consistent with a transplant-derived tumor. This case report both documents a rare long-term complication of olfactory mucosal cell transplantation and serves as a cautionary tale encouraging prudent use of novel treatments in a vulnerable population of patients with severe SCI.

Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury

“…79,[81][82][83] Patients or their decision-makers during vulnerable situations, such as following traumatic injury, may make decisions out of desperation which can beget eagerness to participate and blur the lines of informed consent, particularly when the time window for the intervention is narrow. 79,[81][82][83][84] Several proposals have been made to mitigate these ethical issues. Freedman proposed the widely accepted idea that RCTs are ethical if there is truly clinical equipoise between the 2 treatments-that is, there is no consensus between experts in the field on which treatment is superior.…”

“…For patients with concomitant head injury or decreased level of consciousness (e.g., shock), this puts surrogate decision-makers under pressure to decide unexpectedly if the patient lacks decision-making capacity [ 79 , 81 - 83 ]. Patients or their decision-makers during vulnerable situations, such as following traumatic injury, may make decisions out of desperation which can beget eagerness to participate and blur the lines of informed consent, particularly when the time window for the intervention is narrow [ 79 , 81 - 84 ].…”