Bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells: Case series of 14 patients

The Journal of Spinal Cord Medicine, 2014 · DOI: 10.1179/2045772312Y.0000000069 · Published: January 1, 2014

Spinal Cord Injury Regenerative Medicine

Simple Explanation

This study explores a new approach to treating chronic spinal cord injuries by bridging the gap in the damaged spinal cord using nerve grafts, a special scaffold, and stem cells. The approach involves transplanting stem cells derived from bone marrow into the injury site, along with nerve grafts and a scaffold made of chitosan and laminin. The goal is to encourage nerve regeneration and improve motor and sensory function in patients with chronic paraplegia.

Study Duration

2 years

Participants

14 patients with chronic paraplegia caused by spinal cord injury

Evidence Level

Not specified

Key Findings

1
Motor level improved four levels in 2 cases and two levels in 12 cases.
2
Sensory-level improved six levels in two cases, five levels in five cases, four levels in three cases, and three levels in four cases.
3
The American Spinal Impairment Association (ASIA) impairment scale improved from A to C in 12 cases and from A to B in 2 cases.

Research Summary

This study investigated the effect of bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells. The study found improvements in motor and sensory levels, as well as an improvement in the ASIA impairment scale, in patients who underwent the procedure. The study concludes that mesenchymal stem cell-derived neural stem cell-like cell transplantation enhances recovery in chronic spinal cord injuries with defects bridged by sural nerve grafts combined with a chitosan-laminin scaffold.

Practical Implications

Potential Treatment for Chronic SCI

The findings suggest that this combined approach may offer a promising treatment option for patients with chronic spinal cord injuries, where limited regenerative capacity has been a major challenge.

Stem Cell Enhancement

The study highlights the potential of mesenchymal stem cell-derived neural stem cell-like cells to enhance recovery in chronic spinal cord injuries.

Scaffold and Graft Combination

The combination of nerve grafts with a chitosan-laminin scaffold appears to provide a supportive environment for nerve regeneration and stem cell integration.

Study Limitations

1
Chitosan disintegration leading to post-operative seroma formation was a complication.
2
Although motor power improvement was recorded, this improvement was too low to enable them to stand erect and hold their knees extended while walking unaided.
3
All patients had annoying pain that was not resolved by surgery.

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