The past, present, and future of traumatic spinal cord injury therapies: a review

Bone Jt Open, 2022 · DOI: 10.1302/2633-1462.35.BJO-2021-0177.R1 · Published: May 1, 2022

Spinal Cord Injury Regenerative Medicine Neurorehabilitation

Simple Explanation

This review outlines advancements in care for patients with traumatic spinal cord injury (SCI) over the last century. Current treatment is limited to symptomatic relief, avoiding secondary insults and preventing additional sequelae. The review also discusses potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
There remains limited commercial interest in developing innovative therapies for SCI due to multiple mechanisms that drive delayed injury and a low incidence of injuries each year worldwide.
2
Systemic hypoxia can result from the paralysis of ventilatory muscles and systemic hypotension from haemorrhagic or neurogenic shock.
3
The dense glial scar compartmentalizes and attenuates the spread of any further toxicity via the adhesive prop-erties of the CSPGs.

Research Summary

This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. Many advances have been made in the understanding of the pathological processes after traumatic SCI, and equally there are increasingly innovative techniques which have potential to ameliorate both the structure and function of the injured human spinal cord.

Practical Implications

Stem Cell Therapies

The development of embryonic stem (ES) cells and induced pluripotent stem (iPS) cells is expected to revolutionize medical treatment of diseases which are otherwise incurable.

Bio-scaffolds

Biodegradable polymer scaffolds composed of collagen, chitosan, agarose, and fibronectin have been tested in animals to repair damage to spinal cords.

Stimulation adjuncts to spinal rehabilitation

Epidural electrical stimulation (EES) was incidentally found to improve motor function in patients suffering from MS, with an original premise to reduce neuropathic pain.

Study Limitations

1
Differences exist between rodent and human spinal cords in motor & sensory systems, immune systems, secondary injury, and stem cell characteristics.
2
Standardized protocols for advanced and costly treatments for SCI are yet to be determined.
3
There are many risks and potential disabling long-term consequences for patients which require caution with any experimental spinal cord intervention.

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