The Evaluation Report w/ Specific Procedures & Costs

Evaluation, Proposed Treatment and Cost Estimates for Treatment of Spinal Cord Injury


May 26, 2006

Patient: Gregory Minow


Dear Mr. Minow:


Thank you for visiting our Center in Tijuana, Mexico May 18th, 19th and 20th, 2006 to allow our Spinal Cord Injury Center Team of physicians to evaluate your thoracic injury at level thoracic T8 related to your motorcycle accident that occurred two years ago.


From your previous scans and medical records we can see that your primary treatment was lifesaving and also allowed your spine to recover stability due to the spinal instrumentation.


The evoked sensory potentials and neuro-orthopedic examinations performed by Dr. Lopez Lomely shows that at this time the connection from your cerebral cortex travels freely down to the thoracic 8th (T8) level, where the electrical signals stop, meaning that at this level the spinal cord has a blockage that prevented any electrical stimulation to travel further down.


The condition of your skin is very good, except for two small sores on the right lower extremity.


The blood work shows a complete blood count within normal limits, except for the red blood cells that are on the lower borderline levels with 4.7 million red cells and 14 grams of hemoglobin.


Dr. Astorga, Internist and Neuro-anesthesiologist and specialist in intensive care therapy, advises you to be on a vitamin B-complex with iron, which could be prescribed by your primary care physician or obtained at a good health food store.


Your white cells and immune system are normal as well.  The SMAC 29 shows normal blood sugar, a kidney function within normal limits as well as liver function along with the blood electrolytes (minerals) being normal.  Cholesterol and triglycerides are normal, and urine is clear with no bacterial infections at this time.


You have a B-positive blood type and normal blood coagulation.


Your heart and lungs are in very good condition as shown on the electrocardiogram and lung tests.


Review of your old scans and x-rays of the thoracic spine, and the new ones requested by chief neurosurgeon Dr. Carlos Romero Gaitan, shows a very stable spine imaged by CT Scan with dye contrast, which shows 30% of the spinal nerves compressed by scarring tissue with an intact dural sac, and a cyst called a syrinx at the thoracic 8th level.


The meaning for all of this information is that you are eligible for endoscopic surgery in order to remodel your spinal canal, to decompress your spinal cord and to have an implant of spinal and neural cells at the level of injury, which will allow your spinal cord to recover when combined with at least 4 hours of physical therapy daily, guided by our physical therapy and rehabilitation team.


Follow up protocol  will also require a daily regimen of  4-aminopyridine (4-AP), a substance that enhances growth of the myelin sheath that surrounds nerve axons and contributes to the transmission of electrical impulses, thus assisting in recovery.


In order to speed the growth of the spinal grafts we also recommend the use of magnetic fields daily by providing you with a portable magnetic field device for you to use at home for approximately four hours each day.  Research indicates that it is quite effective in contributing to recovery.


We now have two choices for spinal cord cell implantation or grafts.  The first is the use of Blue Shark embryonic cell implantation that we have used for 15 years.  The second is now the ability to use umbilical cord cells that have been shown to grow faster and stronger than shark cells, both with no sign of rejection.


There is also a new trend of having booster treatments by implanting cells into the dural sac via a procedure similar to a spinal tap.  These are recommended at three to six month intervals.  The procedure is conducted in the operating room with light sedation anesthesia performed at the level of recovery and is considered to be an outpatient procedure, releasing you to your hotel two hours after the implantation, which takes about one hour.


This visit also allows us to review your recovery and provide assessment on more detailed physical therapy.


We may also need CT Scans with dye contrast or MRIs every 6 months below the level of injury, to show signs of recovery on your spinal cord and syrinx.   We will also want to repeat the evoked sensory potentials examination, which will show the degree to which impulses in the motor and sensory matrix are traveling below the level of injury.


The primary surgical procedure does not require removal of the spinal instrumentation at this time, unless at some future time there is pain associated with the plates and screws.


Therefore our plan is to do a microsurgical decompression of the spinal cord and narrow spinal canal with flexible endoscopes that allow our neuro-orthopedic team to work through a small incision at the level of the original injury (T8), providing decompression three levels down as shown by the CT Scan with dye contrast.


At the same time, Dr. Ramirez, spinal orthopedic surgeon, places the grafts at the level of injury to allow the spinal nerves to grow into the effected levels below.


We anticipate 6 to 8 hours of surgical decompression under general neuro-anesthesia and a hospital recovery of about two days in a general hospital with state of the art equipment for surgery and recovery.


Proposed Microsurgical Neuro-Orthopedic Procedures


The following procedures are recommended, following the international code of procedures terminology (CPT).



Laminectomy and Decompression


Laminectomy with Microscopic Decompression of Spinal Cord


Decompression of the Spinal Cord (e.g., spinal stenosis) with Remodeling of the Spinal Canal


Decompression of Spinal Cord or Nerve Roots including Osteophitectomy


Laminectomy with Drainage of Cyst or Syrinx Excision


Laminectomy for Excision or Evacuation of Intraspinal Lesion, Extradural


Laminectomy for Excision of Intradural Lesions


Dural Graft, Spinal (If needed).


Grafts and Implants


Bone Graft, Any Donor Area, Minor or Small (Dowell or Button)




Not yet available for stem cell implantation.





  • Estimated anesthetic and surgical time for procedures: 7 to 9 hours.
  • Intensive care if needed: 24 hours.
  • Recovery room post surgical: 12 hours monitored.
  • Hospital stay if no complications: 2 to 4 days.
  • Hospital stay if additional rest required: 5 days.




Surgeons and Physicians


Spinal Orthopedic Team


Dr. Fernando Ramirez del Rio.

Spinal microsurgeon. Medical Director. International Spinal Cord Regeneration Center.


Neurosurgical Team


Dr. Carlos Romero Gaitan

Neuromicrosurgeon. Head of Neurosciences. Autonomous University of Baja California, Mexico.


Dr. Enrique Sanchez Valera

Neuromicrosurgeon. Chief of Neurology and Neurosurgery. Hospital General, Baja California Norte.


Neuroanesthesiology Team


Dr. Jorge Astorga Ibarra

Chairman. Critical Care Team ISCRC.


Dr. Carlos Valencia

Associate Neuroanesthesiologist.




Certified Radiology Technician Prof. Jose Luis Calleros to us the C-Arm during surgery to locate the T8 surgery level.



Expenses Related to the Procedures and Post Operation Materials


Dr. Fernando Ramirez del Rio


Dr. Carlos Romero Gaitan


Dr. Enrique Sanchez Varela


Dr. Jorge Astroga Ibarra and Dr. Valencia


Shark embryonic cultured cells.                                ** (Option A)


Umbilical Cord Stem Cells for three vials with

2 million cells each, proneural and spinal.                      (Option B)



Hospital stay, private room and medicines


ISCRC Administrative Fee @ 10%




Sub-Total for surgery, based on use of Umbilical Cord Cells

** $51,700.00

(If based on embryonic shark stem cell implantation.)




Post-Op and Follow-up Materials and Medicines


4-Aminopyridine 10 mgs caps long release 12 vials with 50 caps for 1 year supply


Portable pulsating magnetic field generator device


Follow-up spinal tap procedures including spinal and neural shark cultured cells.                                                                  (Option A)


If human umbilical cord cells are to be used, add for every vial of proneural primitive cells with 2 million count cells. (Option B)


Average follow up procedure and evaluation every 3 o 6 months, for approx. 2 years or until full recovery.


Prices include Operating room, recovery and Dr. Astorga anesthesiologist with Dr. Rasmirez placing the graft cells intradural at ISCRC.






Dr. Fernando Ramirez del Rio

Medical Director


Robert M. Lewis, Ph.D.

Business Administrator