The "Gemini" spinal cord fusion protocol: Reloaded.

Abstract

Sir, Cephalosomatic anastomosis (CSA), that is, the surgical transference of a healthy head on a surgically beheaded body under deep hypothermic conditions, as conceived by Robert White,[39] hinges on the reconnection of the severed stumps of two heterologous spinal cords (reviewed in reference).[7] On the occasion of the first CSA between primates in 1970, Dr White hewed to the view that a severed spinal cord could not be reconnected, thus leaving the animal paralyzed.[7,39] In 1902, Stewart and Harte reported on CN, aged 26 years, who had her spinal cord severed by a 0.32 caliber gunshot. The distance between the segments of the cord was 0.75 inch, as verified by all five attending physicians: “The ends of the cord were then approximated with 3 chromicized catgut sutures passed by means of a small staphylorraphy needle, one suture being passed anteroposteriorly through the entire thickness of the cord and the other two being passed transversely. This part of the operation was attended with unusual difficulties because of…the wide interval between the fragments, the catgut frequently tearing out before the ends were finally brought together.” Sixteen months later, “the patient slides out of bed into her chair by her own efforts and is able to stand with either hand on the back of a chair, thus supporting much of the weight of the body.”[36] Importantly, they reviewed several cases of patients with sharp wounds to the cord that spontaneously recovered from initial paraplegia. Their conclusion was that “the operation of myelorrhaphy will be specially indicated in cases in which the cord has been cut by a sharp instrument or severed by a projectile.”[36] Whereas myelorrhaphy was not effective at 15 months in a young paraplegic patient after a self-inflicted 0.38 caliber gunshot,[16,35] nonetheless, a huge body of evidence accrued over the past decades made the first part of Stewart and Harte's prediction highly relevant.[33] In fact, had White attempted to reattach the sharply severed cord stumps in the monkey, the possibility exists that the animal might have recovered at least partial motricity. In this paper, I will detail the recently proposed GEMINI spinal cord fusion (SCF) protocol in view of the first human CSA,[7] giving new meaning to Stewart and Harte's prediction. The recent study by Estrada et al.,[14] in which rats whose spinal cords were sharply transected recovered ambulation, confirms that CSA (HEAVEN: 7) is feasible. Two key principles underlie the GEMINI SCF: A sharp severance of the cords is not as damaging as clinical spinal cord injury The gray matter “motor highway” is more important than the pyramidal tract in human motor processing.