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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Jul;71(1):73–80. doi: 10.1136/jnnp.71.1.73

Prospective study of omental transposition in patients with chronic spinal injury

J Duffill 1, J Buckley 1, D Lang 1, G Neil-Dwyer 1, F McGinn 1, D Wade 1
PMCID: PMC1737462  PMID: 11413267

Abstract

OBJECTIVES—This prospective study was designed to assess the effects of omental transpostion in patients with a chronic spinal injury.
METHODS—Neurological status was established to be stable and multiple baseline across patient studies were done preoperatively and repeated postoperatively. Assessments included activities of daily living (ADL), functional ability, degree of spasticity, motor power, sensation, pain perception, urodynamic studies, electromyography, sensory evoked potentials (SEPs), and infrared thermography to measure peripheral and general skin vascular responses. Each patient had MRI. Assessments were done at 3, 6, and 12 months after omental transposition in 17patients.
RESULTS—The detailed assessments failed to show significant improvement, although some patients showed minor objective and subjective change in some categories. Neurological deterioration occurred in one patient. There were 20 surgical complications including urinary tract infection, deep vein thrombosis, wound infection, and incisional hernia.
CONCLUSIONS—Omental transposition has not been shown to improve neurological function in 17 patients with chronic spinal cord injury, and continued use of this operation in this situation is not supported by this study. Further advances in spinal cord repair may utilise the pedicled omental graft to provide an alternative vascular supply, but its current use should be limited to experimental models.



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Selected References

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  1. Abraham J., Paterson A., Bothra M., Mofti A. B., Taylor G. W. Omento-myelo-synangiosis in the management of chronic traumatic paraplegia: case report. Paraplegia. 1987 Feb;25(1):44–49. doi: 10.1038/sc.1987.12. [DOI] [PubMed] [Google Scholar]
  2. Alday E. S., Goldsmith H. S. Surgical technique for omental lengthening based on arterial anatomy. Surg Gynecol Obstet. 1972 Jul;135(1):103–107. [PubMed] [Google Scholar]
  3. Björklund A. Spinal cord repair. A question of making it work. Nature. 1994 Jan 13;367(6459):112–113. doi: 10.1038/367112a0. [DOI] [PubMed] [Google Scholar]
  4. Bohannon R. W., Smith M. B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206–207. doi: 10.1093/ptj/67.2.206. [DOI] [PubMed] [Google Scholar]
  5. Bracken M. B., Shepard M. J., Collins W. F., Jr, Holford T. R., Baskin D. S., Eisenberg H. M., Flamm E., Leo-Summers L., Maroon J. C., Marshall L. F. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg. 1992 Jan;76(1):23–31. doi: 10.3171/jns.1992.76.1.0023. [DOI] [PubMed] [Google Scholar]
  6. Clifton G. L., Donovan W. H., Dimitrijevic M. M., Allen S. J., Ku A., Potts J. R., 3rd, Moody F. G., Boake C., Sherwood A. M., Edwards J. V. Omental transposition in chronic spinal cord injury. Spinal Cord. 1996 Apr;34(4):193–203. doi: 10.1038/sc.1996.38. [DOI] [PubMed] [Google Scholar]
  7. Curati W. L., Kingsley D. P., Kendall B. E., Moseley I. F. MRI in chronic spinal cord trauma. Neuroradiology. 1992;35(1):30–35. doi: 10.1007/BF00588274. [DOI] [PubMed] [Google Scholar]
  8. Ditunno J. F., Jr, Formal C. S. Chronic spinal cord injury. N Engl J Med. 1994 Feb 24;330(8):550–556. doi: 10.1056/NEJM199402243300808. [DOI] [PubMed] [Google Scholar]
  9. GUTTMANN L., SILVER J., WYNDHAM C. H. Thermoregulation in spinal man. J Physiol. 1958 Aug 6;142(3):406–419. doi: 10.1113/jphysiol.1958.sp006026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Goldsmith H. S. Brain and spinal cord revascularization by omental transposition. Neurol Res. 1994 Jun;16(3):159–162. doi: 10.1080/01616412.1994.11740218. [DOI] [PubMed] [Google Scholar]
  11. Goldsmith H. S., Chen W. F., Duckett S. W. Brain vascularization by intact omentum. Arch Surg. 1973 May;106(5):695–698. doi: 10.1001/archsurg.1973.01350170061015. [DOI] [PubMed] [Google Scholar]
  12. Goldsmith H. S., Duckett S., Chen W. F. Prevention of cerebral infarction in the dog by intact omentum. Am J Surg. 1975 Sep;130(3):317–320. doi: 10.1016/0002-9610(75)90393-1. [DOI] [PubMed] [Google Scholar]
  13. Goldsmith H. S., Duckett S., Chen W. F. Prevention of cerebral infarction in the monkey by omental transposition to the brain. Stroke. 1978 May-Jun;9(3):224–229. doi: 10.1161/01.str.9.3.224. [DOI] [PubMed] [Google Scholar]
  14. Goldsmith H. S., Duckett S., Chen W. F. Spinal cord vascularization by intact omentum. Am J Surg. 1975 Mar;129(3):262–265. doi: 10.1016/0002-9610(75)90236-6. [DOI] [PubMed] [Google Scholar]
  15. Goldsmith H. S., Griffith A. L., Catsimpoolas N. Increased vascular perfusion after administration of an omental lipid fraction. Surg Gynecol Obstet. 1986 Jun;162(6):579–583. [PubMed] [Google Scholar]
  16. Goldsmith H. S., Griffith A. L., Kupferman A., Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA. 1984 Oct 19;252(15):2034–2036. [PubMed] [Google Scholar]
  17. Goldsmith H. S., Marquis J. K., Siek G. Choline acetyltransferase activity in omental tissue. Br J Neurosurg. 1987;1(4):463–466. doi: 10.3109/02688698708999637. [DOI] [PubMed] [Google Scholar]
  18. Goldsmith H. S., McIntosh T., Vezina R. M., Colton T. Vasoactive neurochemicals identified in omentum: a preliminary report. Br J Neurosurg. 1987;1(3):359–364. doi: 10.3109/02688698709023778. [DOI] [PubMed] [Google Scholar]
  19. Goldsmith H. S., Neil-Dwyer G., Barsoum L. Omental transposition to the chronically injured human spinal cord. Paraplegia. 1986 Jun;24(3):173–174. doi: 10.1038/sc.1986.23. [DOI] [PubMed] [Google Scholar]
  20. Goldsmith H. S., Steward E., Duckett S. Early application of pedicled omentum to the acutely traumatised spinal cord. Paraplegia. 1985 Apr;23(2):100–112. doi: 10.1038/sc.1985.18. [DOI] [PubMed] [Google Scholar]
  21. Gresham G. E., Labi M. L., Dittmar S. S., Hicks J. T., Joyce S. Z., Stehlik M. A. The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients. Paraplegia. 1986 Feb;24(1):38–44. doi: 10.1038/sc.1986.7. [DOI] [PubMed] [Google Scholar]
  22. Holbrook M., Skilbeck C. E. An activities index for use with stroke patients. Age Ageing. 1983 May;12(2):166–170. doi: 10.1093/ageing/12.2.166. [DOI] [PubMed] [Google Scholar]
  23. Khosla A., Bowen B. C., Falcone S., Quencer R. M., Green B. MR of omental myelosynangiosis. AJNR Am J Neuroradiol. 1995 Feb;16(2):275–279. [PMC free article] [PubMed] [Google Scholar]
  24. Li C., Houlden D. A., Rowed D. W. Somatosensory evoked potentials and neurological grades as predictors of outcome in acute spinal cord injury. J Neurosurg. 1990 Apr;72(4):600–609. doi: 10.3171/jns.1990.72.4.0600. [DOI] [PubMed] [Google Scholar]
  25. Lucas J. T., Ducker T. B. Motor classification of spinal cord injuries with mobility, morbidity and recovery indices. Am Surg. 1979 Mar;45(3):151–158. [PubMed] [Google Scholar]
  26. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  27. Masumori Y., Nagashima C., Nakamura H. Experimental omento-myelo-synangiosis. Surg Neurol. 1992 Dec;38(6):411–417. doi: 10.1016/0090-3019(92)90108-y. [DOI] [PubMed] [Google Scholar]
  28. Piepmeier J. M., Jenkins N. R. Late neurological changes following traumatic spinal cord injury. J Neurosurg. 1988 Sep;69(3):399–402. doi: 10.3171/jns.1988.69.3.0399. [DOI] [PubMed] [Google Scholar]
  29. Rafael H., Malpica A., Espinoza M., Moromizato P. Omental transplantation in the management of chronic traumatic paraplegia. Case report. Acta Neurochir (Wien) 1992;114(3-4):145–146. doi: 10.1007/BF01400604. [DOI] [PubMed] [Google Scholar]
  30. Sherman R. A., Ernst J. L., Markowski J. Relationships between near surface blood flow and altered sensations among spinal cord injured veterans. Am J Phys Med. 1986 Dec;65(6):281–297. [PubMed] [Google Scholar]
  31. Tessler A. Intraspinal transplants. Ann Neurol. 1991 Feb;29(2):115–123. doi: 10.1002/ana.410290202. [DOI] [PubMed] [Google Scholar]
  32. Wang D., Bodley R., Sett P., Gardner B., Frankel H. A clinical magnetic resonance imaging study of the traumatised spinal cord more than 20 years following injury. Paraplegia. 1996 Feb;34(2):65–81. doi: 10.1038/sc.1996.13. [DOI] [PubMed] [Google Scholar]
  33. de la Torre J. C., Goldsmith H. S. Collagen-omental graft in experimental spinal cord transection. Acta Neurochir (Wien) 1990;102(3-4):152–163. doi: 10.1007/BF01405432. [DOI] [PubMed] [Google Scholar]
  34. de la Torre J. C., Goldsmith H. S. Increased blood flow enhances axon regeneration after spinal transection. Neurosci Lett. 1988 Dec 5;94(3):269–273. doi: 10.1016/0304-3940(88)90029-8. [DOI] [PubMed] [Google Scholar]

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