Protection and Repair After Spinal Cord Injury: Accomplishments and Future Directions

Traumatic spinal cord injury (SCI) is a devastating neurological problem that affects over 12,000 people each year in the United States. SCI is a worldwide problem with thousands of individuals in many countries sustaining injury from a variety of mechanisms including vehicular accidents, sporting events, and violence. SCI can result in a spectrum of neurological problems including the loss of motor and sensory function, bowel and bladder dysfunction, spasticity, neuropathic pain, and autonomic dysreflexia. Although a great amount of information is known about the pathophysiology of SCI and the cellular and molecular events that lead to cell death and neurological deficits, there is a lack of successful therapies in the clinic that protect or promote recovery after injury. Neurorehabilitation is known to improve the strength and function of people living with SCI. New strategies including robotic training and electrical stimulation studies are providing evidence for these approaches enabling spinal cord circuits to respond to stimulation and participate in recovery mechanisms after SCI.

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  Early decompression surgical procedures after severe SCI have been examined in both preclinical and clinical studies. Evidence suggests that these early surgical interventions are safe and effective, and they are currently recommended as an early intervention for patients with acute severe SCI.
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  Clinical outcomes using modest intravascular hypothermia after acute cervical spinal cord injury. Importantly, at 1 year after severe cervical SCI, an approximate 43% conversion of AIS As to Bs and Cs was reported. Taken together, these results are encouraging and indicate that this experimental therapeutic approach is safe.
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  Schwann cell transplantation is associated with the release of growth-promoting factors, axonal regeneration, and remyelination. In addition to rodent studies, Schwann cell transplantation protocols have been conducted in larger SCI animal models including minipigs and nonhuman primates with supportive results.