[Home] [Therapies]



Laurance Johnston, Ph.D.

Brian Sternberg was not just a superb athlete; he was the best. In 1963, the University of Washington junior established a world pole vault record of 16’8” and seemed destined to be the first to break 20 feet. His gymnastic background had made him a strong, agile athlete, hence, especially well suited for the new, flexible, state-of-the-art fiberglass poles.

Practicing on the trampoline as he often did, Sternberg tried a maneuver that he had routinely carried out in this past. This time, something went wrong. Landing awkwardly on his neck, he sustained a C4-5 spinal cord injury (SCI).Brain Sternberg and spinal cord injury (SCI) and omentum

More than three decades later in 1996, surgeon Harry Goldsmith operated on Sternberg, who says the omentum surgery greatly increased his quality of life. For example, because Sternberg’s injury affected the nerves controlling respiration, he could only speak in a whisper before surgery. Since then, his voiced has increased by about 60%.

“I wouldn’t have been able to have this conversation with you before the operation”  Sternberg told me. He says his overall health and strength has greatly improved. For example, the operation has reduced the incapacitating pain that he once had.

 “Before the surgery, on a scale of 1-10, my pain averaged 8-13, “ Sternberg says. “Now it is 1-2.”

He has more feeling in extremities and improved circulation. He can stay upright for long periods of time, a problem before the surgery. In a Sports Illustrated article (September 21, 1998), Brian has stated that the operation “has made all the difference in the world.”


Omental transposition is a controversial surgery used to treat spinal cord injury (SCI). In this procedure, the omentum, a physiologically dynamic, fatty membranous tissue surrounding the intestinal and lower abdominal region, is surgically lengthened and placed over the area of injury.

Goldsmith pioneered this procedure for various central nervous system disorders, including SCI. Currently associated with the University of Nevada’s School of Medicine (Reno), Goldsmith has spent much of his career investigating omentum’s therapeutic potential. His work has stimulated many others who have now treated thousands of patients for spinal cord injury, and other neurological disorders, such as stroke, cerebral palsy, Alzheimer’s disease, and Parkinson’s disease.

The procedure’s acceptance has grown greatly in other parts of the world, such as in China where more than 3,000 people with spinal cord injury have had omental surgery. In the United States, however, the conservative SCI research community has been reluctant to evaluate omental therapy for a variety of reasons.

First, many researchers urge caution when considering a new therapy like this that involves an inherently risky surgery that tampers with the spinal cord.  Second, omental surgery’s radical nature falls outside of prevailing SCI research perspectives and priorities. As such, in a “see-it-when-I-believe-it” attitude, the SCI scientific community tends to see the omental approach’s flaws that reinforces their preconceptions rather than the evidence that would require them to change their view.

Third, although many have had omental surgery, the value of this clinical experience, especially when originating in other countries, does not count much in the U.S. scientific court of judgement. Scientists believe that the only evidence that really matters is that generated by rigorously designed, controlled clinical trials, which have not as yet been carried out for omental surgery.

Fourth, the therapy’s image was dealt a blow after a mid-1990’s controversy in which an unauthorized, recruiting agent was accused of over promoting omentum’s therapeutic benefits. As controversy enveloped the procedure, combined with some supposedly, negative research findings (see below), the momentum for the therapy shifted to other countries.

Goldsmith continues to be a tireless omental therapy advocate. Several benefactors have recently donated $2 million dollars to establish the Omental Research Foundation to support his efforts. He plans to use these funds to help defer the high patient cost of the surgery and fund basic-research pilot studies.


OmentumThe omentum is a highly vascular, fatty tissue approximately 14 inches in length and 10 inches wide that hangs like an apron over the intestines and lower abdomen area. Although the omentum has been viewed as an inert tissue bereft of significant biological function, scientists are now discovering that it is an intriguing, physiologically dynamic tissue with a considerable body of research that supports its therapeutic potential (e.g., see Agner et al, Neurological Research, January, 2001 and The Omentum Application to Brain and Spinal Cord, edited H.S. Goldsmith, Forefront Publishing, 2000):

·        Blood supply: The omentum contains angiogenic factors that stimulate the growth of new blood vessels into whatever tissue it is surgically placed next to, including the brain and spinal cord (see figure).

·        Lymphatic System: The omentum is rich in lymphatic vessels and tissue that are critical in removing metabolic waste and excess fluid, destroying toxic substances, and fighting disease.

·        Immune System: Omental areas called “milky spots” are capable of generating specialized immune cells that facilitate healing. For example, some scientists believe that the migration of omental immune cells, called macrophages, can help repair injured spinal cords.

·        Edema Absorption: The omentum’s lymphatic system has an enormous capacity to absorb edema fluid, including that associated with spinal cord swelling.

·        Source of Biological Material: The omentum is a rich source of biological material that enhance tissue growth, including angiogenic factors, key neurotransmitters, nerve growth factors, and agents involved in inflammatory and immune processes.

·        Stem Cells: Evidence suggests that omental tissue contains stem cells - omnipotent master cells that can differentiate into a variety of cell types. For example, Dr. Ignacio Garcia Gomez (Madrid, Spain) and colleagues demonstrated the presence of stem cells in the human omentum (Neurological Research, 27, December 2005). These cells were shown to synthesize key growth factors that promote vascularization when transplanted.


Omental surgery, a six-hour operation, initially cuts into the abdominal cavity to access the omentum. The omentum is then gently separated from the colon and the stomach in a way that maintains blood and lymphatic circulation (see illustration).omental transposition and spinal cord injury (SCI)  The omentum is then surgically tailored to create a pedicle – a piece of connected tissue of sufficient length with intact circulation to reach the spinal cord injury site, like a square handkerchief would be cut to make a long necktie. The omental pedicle is then tunneled underneath the skin, placed over the exposed cord, and sutured to the cut edges of the dural membrane surrounding the cord.

Because creating the omental pedicle can be tricky, some surgeons use a substitute procedure, in which a free, unattached piece of omental tissue is surgically placed over the injured cord and connected to a surrounding vascular source (e.g., to the carotid artery and jugular vein). Dr. Hernando Rafael in Mexico has mostly used this modified procedure to treat over 250 people with spinal cord injury. Although blood circulation is maintained, because the graft is separated from the omentum’s lymphatic system, the tissue’s ability to absorb fluid is eliminated.


Goldsmith and Rafael estimate that about 40% of their omental SCI patients have regained some function, and Chinese surgeons have reported an even greater improvement rate. 

Critics tend to dismiss such claims, however, because they are often based on subjective evaluation criteria affected by potential doctor or patient biases. These critics believe that improvement can only be documented through validated clinical outcome measures to assess patient function before and after treatment.

In response, advocates believe that restored function is often so great that efficacy cannot be denied. One omental patient noted that his extensive improvement after omental surgery was dismissed by the physician he had been seeing as merely recovery from hysterical paralysis - even though the improvement was five years after his injury.


Since 1975 when Goldsmith first demonstrated that placing the omentum on the injured spinal cord in dogs could revascularize the underlying cord tissue, many animal studies have shown omentum’s therapeutic potential.  For example, numerous projects have evaluated the tissue’s ability to treat a contusion injury that produces a cavity in the cord similar to many injuries in people.  This research indicated that placing an omental pedicle on the injury area will inhibit cavity formation and preserve overall function.

Research in cats has also shown that the omentum can even help repair a totally transected spinal cord. In this research, the gap in the cord was filled with liquid collagen, such as used in cosmetic surgery, that hardens at body temperature. The omental pedicle was then placed over this collagen bridge that formed between the spinal cord stumps.

Compared to control cats, spinal cord blood flow was greatly increased across the omentum-collagen bridge. More importantly, neuronal axons grew through the bridge into the cord on the other side of the gap (see illustration) at a rate of one millimeter per day. This rate is comparable to peripheral nerve regeneration (i.e., the nerves outside of the brain or spinal cord that usually retain regeneration capability). The procedure prevented hind-limb muscle atrophy, and as recorded on video, even allowed some cats to regain coordinated walking ability.


In 1984, Goldsmith carried out the first surgery in a person with spinal cord injury (see below). Although many people with SCI have had omental surgery since that time, a 1996 study (Clifton, et al, Spinal Cord, 34, 1996) appeared to provide the scientific ammunition to dismiss the procedure as a viable SCI treatment.

In this study, 11 patients with spinal cord injury were examined a year after omental surgery using a variety of state-of-the-art assessment procedures and compared to control subjects. The overall results were inconclusive; some subjects appeared to improve, and others did not. Because these ambiguous results were associated with some serious side effects, the investigators concluded that there was “ no justification for further clinical trials of this procedure.”

For most of us in the SCI research establishment, because the study used the correct assessments, it seemed to be the final nail in the coffin for the therapy. However, like newspaper errata that are rarely noticed, few saw Goldsmith’s rebuttal that was published soon after (Spinal Cord, 35, 1997).

Goldsmith claimed that the study’s statistically meaningless conclusions merely reflected the investigator’s existing biases against the procedure. He noted that the investigators had used two different surgical procedures, automatically confounding the study. Over half the time, they had used a free omental tissue graft instead of, as stated in their objectives, an attached omental pedicle. By so doing, they eliminated the tissue’s beneficial fluid-absorbing capability.

Although the study’s goal was to determine the specific effect of the omentum placed directly on the injured cord, the final analysis included outcomes of several patients whose omental graft was shown not even to be physically attached to the cord or had been surgically removed before analysis. In other words, they had factored in results that were not applicable to the stated study objectives, and, hence, significantly skewed the reported results.


Although to date omental surgery has been exclusively directed to long-term chronic injuries, based on animal studies, Goldsmith believes that the procedure may be able to reduce the extensive secondary neurological damage that occurs soon after injury.  The swelling that develops after injury in and around the cord can cut off capillary blood flow, which may prevent therapeutic drugs from reaching the injury site, and creates the scar tissue that that inhibits regenerative processes. Goldsmith says that the spinal-column-stabilizing surgery (i.e., fusion) often carried out after injury is a golden opportunity to reduce the damaging fluid edema by placing the enormously absorptive omentum upon the injured cord.


In addition to Sternberg, the individuals I talked to were enthusiastic about the benefits they had accrued after omental surgery, although they emphasized that one must have realistic expectations.

In 1984, Daren Renna became the first person with a spinal cord injury to be treated by Goldsmith. Several years earlier, as a 17-year old, up-and-coming gymnast who was setting his sights on qualifying for the U.S. Olympic team, Renna had become a C3-4 quadriplegic from a gymnastics accident.  His injury resulted in the loss of virtually all function below the neck except for being able to rotate his hands slightly.

Renna says he has benefited greatly from omental surgery.

“I initially got more balance and had less spasticity. And over the next five years, I regained a lot of arm and wrist function,” he says. “I have pretty good use of my arms now. Overall, I am a much healthier person.”

Goldsmith was moved when Renna later gave him a gymnastics medal in gratitude. Renna has become involved in gymnastics again as a coach and internationally rated official (see photo).

In 1993, Andrea Zobell, a 23-year old German woman, became paraplegic after a skiing accident. An MRI indicated a near total transection of her spinal cord. Although retaining occasional lower leg, light-touch sensitivity, she lost all physical movement below the T6-7 level.

More than three years later, Zobell had omental surgery in which the scar tissue that now filled the 1.6-inch gap in her cord was replaced with an omental-collagen bridge as described above. After recovering from the surgery, she zealously committed to a physical rehabilitation program, which she strongly believes is needed to maximize surgical benefits.

Over the next several years, Zobell gradually gained strength and control of muscles below the injury, Because of increased strength in the back, hip, and abdominal muscles, she could now remain in a sitting position without support. She has regained some ability to move her legs. For example, she can walk when she is in a swimming pool and can get off a chair and stand with some support (see photo). She also has increased awareness of bladder filling.  Andrea’s MRI now shows the continued development of structure connecting the spinal cord segments.


There is too much supporting research and patient experience to continue to ignore omentum’s therapeutic potential. The verdict is not in for this procedure as many of us falsely concluded in the past. We need to open-mindedly gather more evidence, especially well-designed, controlled clinical trials to help definitively determine the procedure’s benefits relative to its risks.

Adapted from “Paraplegia News” March 2001 (For subscriptions, contact

Keep posted on new therapies, treatments, potential cures, and developments!

Sign up for Newsletter!