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Finding Hope After Injury
A pioneering surgery grants one local man a promising future


January 2017

Since his procedure last July, Lucas Lindner can perform simple, everyday normalities — like texting his friends — again.
Photo by David Szymanski

On a Sunday morning in March 2016, 22-year-old Lucas Lindner got in his car to drive to the grocery store and a friend’s house. Shortly after he left home, a deer jumped into the path of his car, and Lucas swerved to avoid hitting it. His right front tire blew out, causing his car to roll and hit a tree.

Lindner was taken by Flight for Life to Froedtert Hospital, where the news was grim. He’d suffered a complete spinal cord injury of the lower cervical cord, with no sensation or motor function below his injury. “Lucas’ injury was C5 and C6, which meant he could shrug, use his biceps in a crude fashion, and bring his hands to his mouth, but he had very gross movements,” says his surgeon, Shekar N. Kurpad, M.D., Ph.D., interim chair of neurosurgery, professor of neurosurgery, and director of Froedtert & the Medical College of Wisconsin’s spinal cord injury program.

When Lindner woke up in the hospital a few days after the accident, he was devastated. He’d been living a full and fast-paced life in his hometown of Eaton, Wis. He was a manager for McDonald’s, traveling to different franchises in Wisconsin and Michigan for the company. He was also a student at Moraine Park Technical College, studying IT system management. Lindner spent what little extra time he had on the computer, learning about coding.

But the accident changed everything. Lindner could move his hands and wiggle his wrists, but he could not move his fingers or do anything that required strength. “The concerning part was the future,” Lindner says, recalling his experience at the time. “What was I going to do? Everything I was working on in my life was lost. ... Was there any point to it?”

The standard course of treatment for spinal cord injury is a stabilizing surgery, which does not help to restore sensory or motor function, and rehabilitation. The spinal cord is delicate and protected by the spinal column, vertebrae and discs. When the bony spine is injured or broken, the small pieces of bone serve as projectiles, bruising the cord. “Someone with a broken neck cannot keep their neck straight, so one of the basic surgeries we’ve done is to remove broken fragments, realign the spine, and put in screws, building a scaffold,” says Kurpad. The surgery helps people sit up, which can prevent them from getting pneumonia. After surgery, the patient is sent to rehabilitation for physical therapy. “He would still be quadriplegic, but (therapists) would teach him how to be independent and integrate into society as well as possible,” Kurpad adds.


Dr. Shekar N. Kurpad calls the research the “single most exciting thing” he’s seen in 20 years.
Photo by David Szymanski

A New Hope

But Kurpad had a promising new option for Lindner — he qualified for a clinical study that might help him regain some function. “This current study looks to improve neurological function with the goal of helping formerly paralyzed patients regain functional use of their arms and hands,” explains Kurpad.

In an injury like the one Lindner experienced, not every cell dies. Some are simply dormant. Nerve cells conduct electrical impulses from the brain to the part of the body that wants to move. And the speed of the conduction is made possible by the insulation that these nerve cells have in the spinal cord, which is provided by a myelin sheath. After an injury, some of the cells lose their insulation. They are alive, but no longer useful in transmitting the impulses. “The theory behind the study is that we’re injecting cells into the substance of spinal cord, so the dormant nerve cells can remyelinate and once again conduct electricity,” says Kurpad. Fifteen years ago, as the recipient of the prestigious William P. Van Wagenen Fellowship from the American Association of Neurological Surgeons, Kurpad conducted cellular transplantation research for spinal cord injury at the Karolinska Institutet in Stockholm. This research became foundational for the surgery Lindner had. “A lot of the basic science research was also done by our team here in Milwaukee. It’s a credit to the Milwaukee environment,” says Kurpad.

The 10 million stem cells that would be used in Lindner’s surgery were developed by Asterias Biotherapeutics, a company based in Fremont, Calif. AST-OPC1 cells are made from a federally approved line of embryonic stem cells that was originally created in 1998 in Dr. James Thomson’s lab in Madison, Wis. These cells were genetically engineered to make myelin.

The surgery Lindner would undergo is a delicate and complex procedure, with a brief window of time for success. The surgical team cannot perform the surgery immediately following the injury, because the inflammation is too great. But they can’t wait much more than a month, because the body forms scar tissue around the injury, making the cells impossible to reach. “We want to catch the time when inflammation has died down and scar tissue has not built up,” says Kurpad. Once the date for the surgery was set, the team determined how many cells to inject and exactly where on the spinal cord the injection would make the most difference. Afterward, Lindner went back to rehab.

And the results were stunning. “Lucas went from a C5-6 to a C7-8 in less than 90 days, which almost never happens. What does that mean?” says Kurpad. “He wanted to be a computer programmer. And now he can because he can use his fingers, hold a cup, hold a straw. He has the spine motor control that makes us human. You can play an instrument, for example. The other thing, your triceps start to work with C7, which means you can transfer yourself. This is the difference between getting pushed around by someone and doing it yourself. There is a huge functional difference between these two.”

Within a week and a half of the surgery, Lindner noticed that his arms and hands were stronger, and he could move his fingers. “When I got home from the hospital, I’d recovered quite a bit in terms of range of motion and dexterity,” says Lindner. “I could use my hands and such, but the strength just wasn’t there. More recently, I’ve been working on the strength. This is the big part of it because that is what allows for independence and opens the door to opportunity in caring for yourself and in becoming a productive member of society.”

Lindner lives with his grandparents, Karen and Dave Long. Karen noticed a change in Lindner long before he did. “I saw the results way before the surgery, when he heard about the new study — because he got hope back,” Karen says. “I saw this huge change from trying to accept where he was at to Lucas having hope.”

Reaching Higher

Lindner is still recovering function and movement. He has learned that there’s no set way recovery happens. “I’m trying to be aware of what I wasn’t able to do before that I can do now,” he says. “It’s like I can get used to a certain movement that it doesn’t really dawn on me that it’s something new. And it’s being aware of those things. That’s what you need to work on to get stronger and rebuild those connections, because it’s easy to not notice.”

Lindner’s grandparents have noticed that he is getting stronger and more capable too. When he first came home from the hospital, Karen moved all of her kitchen’s pots, plates and glasses down low, so that Lindner could reach them. “He’s pretty much self-sufficient,” says his grandfather, Dave. “He can fry up his own eggs and get the rest of his food together.” “He can handle plates, microwaving them and grabbing them with one hand,” Karen adds. Recently, Lindner suggested that his grandmother could move the plates back where they were — because between his elevating wheelchair and his increased strength and agility, Lindner can reach much higher than he used to.

Lindner is looking forward to reaching higher throughout the rest of his life. “In the long term, I want to stick with IT, because, even at this point in time, it is completely doable. It goes back to what I initially said, worrying that everything I’d done and been interested in and passionate about my whole life up until that point would have been a waste. But it wasn’t, because I can do all of that,” he says. “I mean, you don’t type with your feet. I’m already to the point where I can do everything that I wanted to do, and I’m still getting signs of improvement to this day.”

Lindner plans to go back to school this January, easing back into it by taking online classes from home so that he doesn’t burn out right away. “One of the hardest parts is having enough energy for everything,” he notes. “I have to be cognizant of what my body needs.”

Hope for the Future

Each year in the U.S. more than 17,000 people suffer a severe, debilitating spinal cord injury. Kurpad is hopeful about the future of this research. “This is the single most exciting thing I’ve seen in 20 years,” he says. The study was fairly small — only five patients received the surgery. “But five patients have shown progress in a 90- to 120-day period,” Kurpad stresses. “I’m excited because it’s a clear intervention based on scientific logic producing clear function in a short period of time. Scientifically, anything more than 10 percent is a treatment. Even if there is a 25 percent recovery rate, that is far better. I am hoping for a game-changer.”

Imaging Technology at MCW

The Medical College of Wisconsin is nationally known as a pioneering center for developing functional MRIs. “In Milwaukee, we are developing maps of the spinal cord so we can find the correct spot to inject. That is important because if your injection is off by 2 to 3 millimeters, it won’t show any effect,” says Dr. Shekar N. Kurpad.

When the accuracy is paramount, then the navigation tool plays a vital role. This imaging technology is called a biomarker, and researchers at both the Medical College of Wisconsin and Marquette University are involved in developing it. The functional MRIs help doctors know what parts of the spinal cord are abnormal and how abnormal they are. “This has become important, and many research teams are incorporating this as a necessity with their trial,” adds Kurpad. “They’re using some of these tools to look at how spinal cord architecture changes after injury. Each injury has a unique signature. There needs to be a personalized approach, and we see this in the MRI scans.”


This story ran in the January 20167 issue of: