We have made a retrospective comparative study of patients with spinal cord injury, nine with a diaphragmatic pacemaker and 13 with mechanical ventilation. Clinical outcome, cost and subjective satisfaction with both modalities have been evaluated. The functional status was the same with both types of treatment. Proper management of an electric wheelchair and optimal phonation were attained, respectively, in 100% and 89% of pacers and in 77% and 77% of mechanically ventilated. The rate of hospital discharge and satisfaction with the treatment were significantly better for pacers. The time devoted to ventilatory assistance and cost were also more favourable in this group.

Spinal cord injury (SCI) results in long-term neurological and systemic consequences, including antibody-mediated autoimmunity, which has been related to impaired functional recovery. Here we show that autoantibodies that increase at the subacute phase of human SCI, 1 month after lesion, are already present in healthy subjects and directed against non-native proteins rarely present in the normal spinal cord. The increase of these autoantibodies is a fast phenomenon–their levels are already elevated before 5 days after lesion–characteristic of secondary immune responses, further supporting their origin as natural antibodies. By proteomics studies we have identified that the increased autoantibodies are directed against 16 different nervous system and systemic self-antigens related to changes known to occur after SCI, including alterations in neural cell cytoskeleton, metabolism and bone remodeling. Overall, in the context of previous studies, our results offer an explanation to why autoimmunity develops after SCI and identify novel targets involved in SCI pathology that warrant further investigation.

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In order to assess some of the variables associated with neurological recovery after traumatic spinal cord injury with vertebral fracture, a randomised sample of 100 patients (50 without neurological recovery, and 50 with several degrees of recovery) were selected out of 245 patients admitted to our hospital. Both groups were homogeneous with respect to time lapse to admission, hospitalization time and level of lesion. Of the variables considered, the intensity of the lesion (incomplete) and vertebral displacement (under 30%) were statistically associated with neurological recovery. An age under 30 years at the moment of the injury was also associated with neurological recovery but only in those patients with an incomplete lesion. No correlation was found between the other variables studied such as the degree of vertebral wedging, type of fracture (compression, flexion-rotation) and management (conservative, surgical) and the neurological evolution.