Current and future medical therapeutic strategies for the functional repair of spinal cord injury

Abstract

Spinal cord injury (SCI) leads to social and psychological problems in patients and requires costly treatment and care. In recent years, various pharmacological agents have been tested for acute SCI. Large scale, prospective, randomized, controlled clinical trials have failed to demonstrate marked neurological benefit in contrast to their success in the laboratory. Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. Recently, attempted cellular therapy and transplantations are promising. A better understanding of the pathophysiology of SCI started in the early 1980s. Research had been looking at neuroprotection in the 1980s and the first half of 1990s and regeneration studies started in the second half of the 1990s. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs, and minimize the secondary damage caused by compression of the spinal cord after trauma. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.

Intraspinal transplantation of autologous neurogenically-induced bone marrow-derived mesenchymal stem cells in treatment of paraplegic dogs without deep pain perception secondary to intervertebral disk disease

“…Numerous experimental studies have been reported with different success rates for SCI, however they have not been fully translated into the benefit of patients, both human and also companion animal (14,40). This can be related to many differences between models and clinical cases, including the ones encountered after naturally occurring spinal cord injury (14).…”

New Aspects of Graft-induced Central Plasticity and Neuroregeneration at T 10 in a Rat Model†

“…An advantage is its ability to penetrate the blood-spinal cord barrier. We hypothesized that the acute treatment with CERE resulted in a) cell protection in the region of surgical spinal cord injury by the grafting procedure, b) neuroregeneration, and c) neuro-recovery within both the cord and graft, according to promising reports and evidence from brain and spinal cord lesions [18,19,22,23,28,31,[86][87][88][89][90][91][92][93][94].…”

“…Until now, traumatic paraplegia by severance of the spinal cord (SC) remains an irreversible condition. Basically, current clinical treatment strategies are targeted to promote axon regeneration and outgrowth beyond the scar formation following SC avulsion [1][2][3][4][5][8][9][10][11][12][13][14][15][16][17][18][20][21][24][25][26][27][28][29][30][31][72][73][74][75][76][77][78][79][80][81][82][83][84][85] Previous experimental and clinical studies together with GB have aroused some hope that paraplegic patients might achieve some selective voluntary muscle reinnervation after grafting the first motor neuron to skeletal hip muscles [10,11,25,72,73].…”

Clinical therapeutic guideline for neurorestoration in spinal cord injury (Chinese version 2016)

“…The principles of SCI treatments include early reduction and fixation, combined extramedullary and intramedullary decompression, cell transplantation, early rehabilitation treatment, and complication prevention. 3,8,9,12,13 Prehospital first aid About 25% of the neurological function impairment following spine injury is caused by improper handling; thus, first-aid management for SCI patients should be taken more seriously. The optimal way to handle an SCI patient is that three or more people from both sides or one side should lift the patient horizontally and place him/her on a flat board or a special stretcher, for transporting to specialized hospital by ambulance or helicopter.…”