Acute and chronic MRI changes in the spine and spinal cord after surgical stem cell grafting in patients with definite amyotrophic lateral sclerosis: Post-infusion injuries are unrelated with clinical impairment

ObjectiveTo report MRI spinal changes after surgical infusion of bone marrow stem cells (BMSc) in ALS patients and assess their correlation with clinical events and functional performance.MethodsBMSc were surgically injected in the thoracic spinal cord of 11 ALS patients (6/5 male/female; median age 46 years). We performed first-week and third, sixth, ninth and twelfth post-surgical months spinal MRIs. The spinal changes in the postsurgical week and follow-up MRIs, as well as clinical events, functional scales and respiratory and electromyography data, were longitudinally monitored. Correlations between the imaging and clinical data were evaluated with the Spearman's test.ResultsTransient extradural fluid collections (100%), transient spinal cord T2 hyperintensity (81.8%), and chronic spinal cord deformities (63.6%) were the dominating MRI changes. Spinal cord hemorrhages (27.3%) and cystic myelomalacia (1/11 patients) were important although unusual findings. During the follow-up, minor adverse events of mild to moderate intensity eventually improved. Initial and follow-up imaging scores showed a strongly positive correlation (r 0.879, P < 0.001). The initial and delayed clinical scores did not correlate. There was no significant correlation between any of the imaging scores and clinical data.ConclusionsInfusion of BMSc produces a variety of spinal changes apparently unrelated with clinical events and disease worsening.