One hundred and fifty three patients who had sustained a spinal cord injury more than 20 years previously were assessed neurologically and by MRI scanning of their spinal cords. The spinal cord pathologies shown were, in order of prevalence, extended atrophy, malacia, syrinx, cyst, disruption and tethering. There was no relationship between the prevalence of any type of pathology and the degree of spinal canal compromise or angulation of the spine adjacent to the level of injury. Neurological changes after initial neurological stabilisation were seen only in patients with extended atrophy, malacia or a syrinx, not in those with only a cyst or cord disruption. Tethering is always associated with other lesion(s). Longer syrinxes were more likely to have associated neurological changes than shorter ones. The most common neurological change was pain.
The medical records of 46 consecutive patients who have had intrathecal Baclofen drug delivery systems implanted in the National Spinal Injuries Centre, the Paddocks Hospital Spinal Unit, Princes Risborough, Lodge Moor Hospital Spinal Unit, Sheffield, the Northern Regional Spinal Injuries Unit, Hexham and The Radcliffe Infirmary, Oxford, were reviewed. Patients were contacted to describe their views on the treatment. The complications of the treatment are described. Some, such as overdose and meningitis are particularly hazardous. Others, in particular pump tubing revisions, are more of an inconvenience and time consuming for the patient and physician. If the serious risks of this valuable treatment are to be minimized and the therapy applied most effectively than a well co-ordinated team is essential, involving in particular the physician responsible for the initial assessment and follow-up of the patient and an experienced surgeon. It is recommended that only a small number of centres in the UK undertake these implants.
To ensure early mobilization, early spinal surgery must be supported by specialized comprehensive care.
Clinical translational science: Clinical translational science (CTS) is a new discipline bridging laboratory discoveries and clinical applications. It is normally funded by research grants instead of investment of major pharmaceutical companies. It is patient-and population-or community-oriented. Repair of the human central nervous system (CNS) using cell therapy can be classified as belonging to this discipline. Darwin's theory of evolution:The success of cell therapy depends upon a correct understanding of Darwin's theory of evolution. Restoration of the structures and functions of the human CNS is no exception. Regrettably, evolution is not generally known or acknowledged.The key factor in cellular evolution is molecular evolution because the protein molecule is the building block of life. The 3 phases of evolution are reproduction, selection, and mutation. The first two phases are relatively controllable, whereas the third phase is not. Benign mutations generate useful proteins. Harmful mutations may result in resistant bacteria, viruses that are more toxic, and neoplasms (benign and malignant). Cells of the ancient systems:Neural structures and functions of the human CNS are relatively immune to self-repair. This immunity developed during the almost 600 million years of animal evolution to protect the most important organs from growth of nerve cell neoplasms. Cell therapy was introduced to overcome this barrier. Primitive stem cells transplanted into human bodies may not grow into the right functional nerve cells but on the contrary can even cause further damage. Fully developed cells may have lost their potential for further evolving. Theoretically, cells in between these two extremes, such as progenitor nerve cells, are the rational choice. They retain sufficient potential to grow, but without the danger of going astray. However, their utility in cell therapy remains to be seen. Cells of the surviving ancient systems (olfactory, limbic, and reticular) in the human body are either good action cells or target cells for neural restoration. Olfactory ensheathing glial cells have
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