Treatment for Spinal Cord Injury Patients from1970 to today

The National Spinal Cord Injury (SCI) Database (USA) was created in 1973 and takes data from around 13% of new SCI cases in the U.S. Since it began, 26 federally funded Model SCI Care Systems have added data to the National Database.

Age at injury: SCI mainly affects young adults. From 1973 to 1979, the average age at the time of injury was 28.7 years. Most injuries happened to people aged 16 to 30. However, the average age of the general population of the U.S. has increased by approximately 8 years since the mid-1970’s. Thus, the average age at injury has also steadily got higher. Since 2005, the average age at injury is now around 40.2 years.

Gender: Currently, 80.9% of reported spinal cord injuries reported are among males.

Etiology: Since 2005, 42.1% of cases were caused by motor vehicle accidents. The next most common cause of SCI is falls. After this comes acts of violence (mostly caused by gunshot wounds), and accidents occurring during recreational sports.

Neurologic level and extent of lesion:

Tetraplegia; injuries to one of the eight cervical segments of the spinal cord.

Paraplegia; lesions in the thoracic, lumbar, or sacral regions of the spinal cord.

The most frequent neurologic categories reported to the database are

Incomplete tetraplegia (30.1%),

Complete paraplegia (25.6%)

Complete tetraplegia (20.4%) and

Incomplete paraplegia (18.5%)

Less than 1% of people had a complete recovery by the time they were discharged from hospital.

Over the last 15 years

The percentage of people suffering incomplete Tetraplegia has increased slightly

The percentage of peoples suffering Complete Paraplegia has decreased slightly.

Residence: Today 87.8% of all persons with SCI who are discharged alive from hospital are sent to a private, non-institutional residence (in most cases this is their homes before injury.) Only 5.7% are discharged to nursing homes.  The remainder are discharged to hospitals, group living situations or other destinations.

Length of stay: Hospital stays and time in rehab has more than halved since the 1970’s.

Average number of days spent in a hospital acute care unit immediately after injury –

1973 to 1979 – 24 days.  Days spent in the rehabilitation unit – 98

Average number of days spent in a hospital acute care unit immediately after injury –

2005 to 2008 – 12 days   Days spent in the rehabilitation unit – 37

Overall, median days hospitalized (during acute care and rehab) were greater for persons with neurologically complete injuries.

Life expectancy for people suffering a SCI continue to increase, but are still below life expectancies for those who have no spinal cord injury.

Mortality rates are at their highest during the first year after injury, especially for those who have suffered a severe spinal injury.

Cause of death:

In the 1970’s, the most common cause of death for people who had suffered a SCI was renal failure. Today, significant improvements in urologic management have shown a great change in the causes of death for SCI patients

The National SCI Database has been able to follow patients who were the first to enrol in 1973 and every year since then. A significant amount of data has therefore been gathered, which now shows the main causes of death for SCI patients to be pneumonia, pulmonary emboli and septicaemia.

How Treatment of Spinal Cord Injuries Has Evolved

The treatment of spinal Cord injuries was not highly proactive for many, many years. It was mostly considered ‘an ailment not to be treated’. As late as 1944, there is a poignant quote by J.R.Silver in his book History of the Treatment of Spinal Injuries.

“In the spring of 1944, I was called to group headquarters for an interview with the group officer, a surgeon of formidable character. ‘Allen,’ he said to me, ‘I am sorry to have to inflict this on you, but we have been ordered to open a spinal unit at Leatherhead Hospital and I want you to take charge of it. Of course, as you know, they are hopeless cases—most of them die, but you must do your best for them.’ With these words of ‘encouragement,’ I returned home sadly” [1].

When the question of treating patients with SCI did surface in medical literature, it was usually to debate the pros and cons of operating, or not operating.

To Operate or Not…

During the early 19th century, two British surgeons were involved in an argument that caused controversy in the medical community. Sir Astley Cooper was in favour of operating on an injured spinal cord. His argument was that without surgery, the patient would die anyway, so there was nothing to be lost by trying it out.  Sir Charles Bell argued that surgery would only increase the risk of death and could potentially damage nerve fibres which could leave the patient without any means of improvement [2].

One of the main reasons that the question of surgery was at the forefront in the treatment of SCI was because of numerous landmark discoveries that had made surgery a much safer option. It would be remiss to leave out these discoveries as they all contributed to surgery being a viable option for SCI patients.

Landmark Discoveries that contributed to making surgery a viable option

Louis Pasteur (1832–1895) advanced knowledge of sterilization as well as the theory of germs.

Ignaz Semmelweis (1818–1865) demonstrated that hand washing and a clean technique could dramatically lower the spread of disease.

Joseph Lister (1827–1912) applied the use of antisepsis to both surgery and the treatment of wounds.

Robert Koch (1843–1910) proved that microbes cause disease.

William Stewart Halstead (1852–1922) created a glove especially for surgery.

Alexander Fleming (1881–1955) discovered penicillin and started the age of antibiotics.

Sir Humphrey Davy (1778–1829) demonstrated the use of nitrous oxide in anaesthetics.

William T. G. Morton (1819–1868) demonstrated the use of ether.

John Snow (1813–1858) demonstrated the use of chloroform.

Karl Landsteiner (1868–1943) discovered the ABO blood typing system.

Landsteiner  and Alexander Weiner (1907–1976) discovered the Rh system, which prevented incompatibilities between a patient and a blood donor, making transfusions and thus surgery safer.

William Conrad Roentgen (1845–1923) discovered the x-ray.

A. Sicard (1872–1929) applied knowledge of radiography to myelography’

William Oldendorf (1925–1992) developed scanning by computerized tomography.

Raymond Damadian, A. Reid, and others – developed magnetic resonance imaging (MRI).

Sir Geoffrey Jefferson (1886–1961) first used halter traction.

Sir Reginald Watson-Jones (1902–1972) created traction by laying the patient between 2 tables.

Gayle Crutchfield (1900–1972) first demonstrated skeletal traction.

Vernon Nickel (1918–1993) and colleagues used the principle of skeletal traction, to create the halo vest.

These methods of traction were particularly important as they created closed reduction and better alignment of the spine, whether the patient was operated on or not.

Despite all of the advances listed above, this yes / no attitude to surgery remained until the first two years of the 1990s when drug treatments began to be used. [3, 4]. 

Surgery Catches Up…

The techniques of surgery needed to improve in order for it to be a viable option. One of the first major contributors to these improvements was Paul Harrington (1911–1980) who introduction of a system of distraction and compression rods and hooks which gave an improved reduction of deformity and stronger stabilization. His original system was designed to treat scoliosis. However, spinal surgeons quickly realised how it could be adapted to treat spinal fractures and dislocations. As Katznelson recognised in his 1969 study, this was particularly relevant to the thoracolum-bar spine [5].

In the next few years, many specialized implantable devices were designed for use in spinal surgery. The main ones were

Pedicle screws – developed by Raymond Roy-Camille

Anterior plates and screws – developed by K. Kaneda and K. Zielke

Pedicle screws and plates – developed by Y. Cotrel and J. Dubousset

It is important to note that despite the huge advances in surgical instruments and techniques, Cooper and Bell’s argument is not completely forgotten because, as demonstrated in a 2006 study, patients with spinal cord injury who don’t have surgery can also have favourable outcomes [6].

A Brighter Outlook

At last, the major advances from many diverse areas of treatment converged to the point where a person with an SCI could realistically be expected to survive the initial injury with their spine in alignment a stabilised.

However, the injury to the spinal cord and the subsequent insults to the organs which relied on the spinal cord for innervations, still create enormous challenges.

There have been some stellar contributors to the understanding and treatment of SCI’s and the associated challenges.

Donald Munro (1889–1973)

Munro’s contribution to this field was so great that he has been awarded the rather strange title of “the father of paraplegia”.

Munro was one of the first physicians who refused to adopt the defeatist attitude to patients with SCI, which was almost universally prevalent. In 1936, he started the first ever unit for the treatment of spinal cord injuries in the U.S. at the Boston City Hospital.

Munro was ahead of his time in his view that a patient with SCI must be treated holistically. He realised that the SCI not only involved multiple areas of the body but also affected the patient emotionally, psychologically and in their socialisation. His views are in line with the treatment of today but at the time, they were seen to be nothing short of revolutionary and he was not supported by fellow specialists at the time.

However, he persuaded the U.S. army to start centers for the treatment of SCI at several hospitals. In those first centres, they implemented his method of ‘tidal drainage’ to help prevent the recurrence of urinary tract infections [7, 8]. This pioneering treatment saved many lives as untreated UTI’s soon escalated into renal failure, which was the most common cause of death to SCI patients. His successes spoke for themselves and became a model for those who subsequently chose to follow, rather than ignore him.

Sir Ludwig Guttmann (1899–1980)

Guttmann escaped from Germany to England in when war broke out in 1939. In 1944 he was given the job of running an SCI unit at Stoke-Mandeville Hospital, which has subsequently become world famous for the treatment of spinal injuries. Under Guttmann’s charge, Stoke Mandeville became a model for SCI centres throughout the British Commonwealth, Asia and Europe. Guttmann learned from Munro’s example that the many aspects of SCI had to be cared for as mentioned in a paper he wrote in 1976 [9]. As part of a patient’s rehabilitation, Guttmann was an advocate of wheelchair sports and founded the Paralympic Games.

Guttmann travelled extensively and while in Australia, he met Sir George Bedbrook (1921–1991). Bedbrook was also a believer in the holistic approach and started an SCI centre in Perth. Bedbrook also travelled all around the glove and spread the word about the ‘new’ treatment of SCI patients.

Ernest H. J. Bors (1900–1990) and A. Estin Comarr (1915–1996) are usually mentioned together because of their massive contributions to the field of SCI.

Multiple inputs converge to create progress

The treatment models of Munro, Guttmann, Bors and Comarr were becoming more widely used but rehabilitation for SCI did not come into wider use until the work of John Young.

John Young (1919–1990)

Young was a great follower of Guttmann and became a member of the International Medical Society of Paraplegia (now called the International Spinal Cord Society) which Guttmann had founded in 1961. He enlisted the help of J. Paul Thomas (Director of the Medical Sciences Program at the National Institute on Disability and Rehabilitation Research (NIDRR) and was given a federal grant in 1971. With this, he expounded how comprehensive care was superior to the fragmented care which was given to SCI patients in Arizona. His new ‘model system’ was quickly recognised and implemented by the NIDRR. This model system was so successful that it is still in use today. There are fourteen of them in the U.S. and they have the largest database on SCI – the National Spinal Cord Injury Statistical Center (NSCISC).

John Young stated that

“a Model System must be able to meet the needs of a person with SCI by competently treating the direct injury as well as all organ systems affected (of which there are many); the functional deficits that result, by providing training and equipment; the psychological adjustments that must be made; the vocational/avocational pursuits that must be changed; and the providing of long-term specialized care.”

He also listed the essential areas of the model system, which he said must include

Emergency medical services;

Emergency trauma care (at a trauma center);

Acute hospital care;

Acute rehabilitation care; and

Ongoing rehabilitation treatment

Alain Rossier (1930–2006) a Swiss Physician, was heavily influenced by Guttmann and became influential in establishing SCI units in Switzerland. He also spent eleven years working in the U.S. at the West Roxbury Veterans Affairs (VA) Hospital, MA.

Rossier became a strong advocate for veterans with SCI. He convinced the VA that more VA hospitals should have specialised SCI units, properly equipped to meet all their patients’ medical, emotional and social needs, for the rest of their lives.

As a result of this, patients with SCI requiring readmission to the designated VA hospitals are admitted to the SCI unit. This is regardless of whether their status is acute or chronic, unless they need intensive care.

Today, this contrasts with most health care payers, who authorize payments to SCI centers. This payment covers acute rehabilitation or rehabilitation related to chronic issues that may be resolved with a short-stay admission.

Meanwhile, increasing numbers of non-VA patients with acute medical problems, (for example, acute urinary tract infection) are admitted to acute general hospitals. However, while patients with chronic medical problems, (for example, leg ulcers) are admitted to long-stay care facilities or they receive treatment at home.

This system is not ideal as it once again exposes the patient to fragmented care, which in turn puts them at risk of suffering complications because the staff in these facilities are not up to speed with the special requirements of patients with SCI. In these settings, the holistic ideals of the pioneers mentioned above need to be brought into play. It seems ironic that following a time of great advancement, a backward step seems to have been taken.

Where Does the Treatment of SCI Stand Today?

Having looked at the major contributions made to the care of patients with SCI, we are now in a position to look at the advances that have been made in that care.

Advances in Treatment of the Spine

As we have already seen, advancements in available instruments and improvements in technique now mean that it is possible to create stability for the spine, get a good reduction, and maintain alignment of the spine. These all contribute to the spine becoming deformed and causing more pain and an increase in disability.

Advances in Imaging

Great leaps have been made in how physicians and surgeons are able to view the SCI of their patients. As shown in a study in 1999, Doctors can now correlate what they see on an MRI scan with the resulting impairment  and can use the information to make a properly informed prognoses. [10] New advancements within the field of MRI include diffusion weighted imaging demonstrated in a study in 2003 [11]. Using this, Doctors can now view the tracts inside the spinal cord. Studies in 2002 demonstrated major advancements such as functional MRI [12] and MRI spectroscopy [13]

Advances in the treatment of Neurogenic Bladder

As previously noted, for many years renal failure was known as the final condition for a paraplegic. This is no longer the case. The following advancements have made pyelonephritis a treatable condition. They have also helped an SCI patient to remain continent which is a great enhancer to their quality of life.

Antibiotics to treat infections (and to prevent them) of the genitourinary (GU) tract;

Anticholinergic medications to maintain continence and bladder compliance;

An anticholinergic is a substance that blocks the neurotransmitter acetylcholine in the central and peripheral nervous system. Anticholinergics inhibit the impulses of parasympathetic nerves by not allowing the neurotransmitter acetylcholine to bind to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the gastrointestinal tract, bladder and urinary tract (also in the GI tract and lungs).

Less invasive ways to remove bladder and kidney stones.

Electro hydraulic lithotripsy (EHL) and Holmium laser lithotripsy are both methods of using laser pulses to break up stones. A thin telescope called ureteroscope can be passed through the natural urinary passage up into the bladder, negating the need for invasive surgery.

Urodynamics to help with understanding the neurogenic bladder and use that knowledge to recommend the most appropriate treatment.

Urodynamics is a study that assesses how well, or how badly, the bladder and urethra are performing their job of storing and releasing urine.

Surgical procedures to enhance bladder storage capacity, facilitate bladder emptying, or increase the ease of catheterization.

These and other treatments have enhanced social continence and quality of life. Studies in 2002 showed how better management of bladder issues have prevented many of the complications that previously shortened life [14, 15]

Advances in the Treatment of Sexuality

A study in 2000 demonstrated that men with erectile dysfunction due to SCI may be treated with oral drugs such as sildenafil citrate [16] (Viagra). If they do not respond to that, injectable prostaglandin E1 (alprostadil) may be tried.

Since many men with SCI also have ejaculatory dysfunction, the collection of sperm by vibratory or rectal electric probe ejaculation or surgically by per cutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) has allowed many to become fathers.

Women with SCI have also benefited from safer labor and delivery and if necessary, safer caesarean sections due to advances in surgery mentioned earlier.

A study in 1996, showed how both men and women now have the opportunity to have more satisfying sexual relations [17].

Advances in the Treatment of Pain

Neuropathic pain (pain in the form of electric shock sensaations, burning, coldness, “pins and needles” sensations, numbness and itching which may be perceived by the patient either at the level of injury or diffusely below it) is an ongoing issue for many people with SCI. Studies in Some anticonvulsant and antidepressant medications can suppress or relieve this pain. Invasive procedures such as implantable spinal cord stimulators and the infusion of morphine and clonidine intrathecally can bring relief in certain cases – which can vastly improve the quality of life. [18, 19]

Advances in the Treatment of Spasticity

Involuntary movement and involuntary resistance to passive movement (caused when some muscles become hypertonic and are unable to be lengthened) may occur in persons with SCI above the conus level – (the tapered, lower end of the spinal cord near lumbar vertebral levels 1 (L1) and 2 (L2). These movements and resistance can become very strong and distressing for the patient. They can make achieving independence in activities of daily living extremely challenging. Oral medications such as baclofen, tizanidine, and dantrolene have been shown to be helpful in reducing spasticity as shown in a study in 2006 [20].

For people who do not gain sufficient relief with oral medications or who cannot tolerate the side effects of a higher oral dose, a 2002 study showed that baclofen delivered via an intrathecal pump can be highly beneficial. [21].

A study in 1998 demonstrated that injecting Botulinum Toxin into an overactive muscle to decrease its level of contraction can allow improved reciprocal motion which will then increase the patient’s ability to move and exercise.[22]

Advances in Care of the Skin

One of the most basic issues in the care of a person with SCI is the care and preferably the prevention of skin breakdown. Limited mobility and loss of sensation can lead to the person suffering pressure sores. A sore can require weeks or months of hospitalisation to allow healing. A deep sore may need surgery or even a skin graft.

Advances in technology have meant that there is now a variety of pressure-relieving surfaces to support people with an SCI.

AbleData have specialist seating, including seating that supports limbs and specialist car seats. They also supply manual and electric wheelchairs and specialist support beds.

FreedomBed has a built in automatic system that turns the person through a 60 degree rotation to change the pressure on a person’s body which can help maintain skin integrity.

Advances in Care of the Bowel

People with SCI may suffer from neurogenic bowel. This may be a hyper reflex bowel which causes constipation or a flaccid bowel which may also cause constipation but with overflow incontinence.

Ironically, some medications commonly used by people with paralysis can also affect the bowel. Anticholinergic medications (previously mentioned for bladder care) may cause constipation or even bowel obstruction.  Some antidepressant drugs, such as amitryptyline; narcotic pain medications as well as some drugs for the treatment of spasticity may also cause constipation.

At its’ most basic, bowels may be evacuated manually.

One advancement is a surgical intervention in which a stoma is created in the patient’s abdomen. This allows an ‘antegrade continence enema’ to be performed – where warm water is introduced via the stoma to flush the bowel.

Another surgical intervention is the creation of a colostomy. This is sometimes required if soiling or pressure sores are an issue.

Advances in Care of the Lungs

The lungs are not affected by paralysis. However, the chest muscles, abdominal muscles and diaphragm may be. Inhaling depends upon muscle strength and if this is compromised, breathing may become an issue.

If the person has paralysis caused by an injury at C3 or higher, the phrenic nerve will not receive stimulation and this means that the diaphragm will not work. In this case, the person will need a ventilator to help with breathing.

If the injury has occurred between C3 and C5, the diaphragm will still function but respiration will still be insufficient.

People with paralysis at the mid-thoracic level and higher may have trouble inhaling, exhaling forcefully and coughing.

All of the above can cause lung congestion which can lead to respiratory infections.

Clearing Mucous Secretions 

It’s now recognised that people with paralysis are at risk of developing pneumonia. This is a serious risk and is one of the leading causes of death in SCI patients, regardless of the level of injury or the length of time since the injury.

Patients on ventilators have lung secretions suctioned from their lungs via tracheostomies every half hour to once a day depending on necessity

Use of Mucolytics

Advances in treatment have led to the use of Nebulized sodium bicarbonate to make sticky secretions easier to suction. Nebulized acetylcysteine is also effective for loosening secretions although care must be taken as it may cause a reflex bronchospasm. 

Cough
A natural cough is necessary to keep the lungs free from secretions. In a SCI patient, this may not be an option. Advancements in treatment have led to various techniques to keep the lungs clear such as

Assisted cough – where a carer firmly pushes against the outside of the stomach and upward, compensating for and recreating the action of the abdominal muscles that causes a deep cough.

Postural drainage – where the patient is positioned with the head is lower than the feet for around 15–20 minutes. Gravity is then able to help secretions to drain from the lungs into a place higher up in the lung where the assisted cough, or suction may be used.

Glossopharyngeal breathing – the patient is encouraged to gulp several fast mouthfuls of air , force that air into the lungs, and then exhaling the air.

Machines can Help

Advances in technology mean that there are now machines available to help with coughing.

 TheVest is an inflatable vest is connected by air hoses to an air pulse generator. This rapidly inflates and deflates the vest. This action applies consistent gentle pressure to the chest wall which loosens mucus secretions and moves them up higher for removal by coughing or suctioning.

CoughAssist mechanically simulates the cough reflex by blowing an inspiratory pressure breath, quickly  followed by an expiratory flow. This creates enough peak air flow to clear secretions.

Both the Vest and the CoughAssist will be reimbursed by Medicare for reimbursement if they are considered a medical necessity.

Cleveland  FES Centre  Researchers are currently working on a trial to see if electrical stimulation of the expiratory muscles is capable of producing an effective cough on demand. The trial is still ongoing and no system is available yet.

Advances in the Treatment of Depression

Depression is now recognised as a completely normal reaction to the devastation a person feels when faced with living with an SCI. Current methods of treatment include –

Psychotherapy

Pharmacotherapy (antidepressants) or a combination of both.

Tricyclic drugs (e.g., imipramine) – often effective for depression but may have intolerable side effects.

SSRIs (Selective Serotonin Reuptake Inhibitors, e.g., Prozac) – less side effects and are usually as effective as tricyclics. Unfortunately, SSRIs may increase spasticity in some people.

Venlafaxine – Among the newest antidepressants, venlafaxine (e.g., Effexor) is chemically similar to tricyclics and has less side effects. It may also bring relief to some forms of neurogenic pain, which is known to be a major reason for depression. It is now realised that alleviating pain plays a large part in preventing depression.

Advances in Rehabilitation

Power wheelchairs can now shift the person’s weight by tilting and/or reclining which helps to retain skin integrity. They can be controlled by head control, sip and puff, voice and eye movement.

Manual wheelchairs are now lighter. This makes them easier to propel and manoeuvre and facilitates loading them into a vehicle. They can also be fitted with power-assisted wheels, for people with reduced upper body strength.

Pressure mapping helps to choose the best wheelchair cushion for the user. This has brought great benefits for those at higher risk of pressure sores.

Lightweight orthotic devices for both upper and lower extremities have made donning and doffing easier and decreased energy cost for ambulatory persons.

Computer interfaces allow individuals with high tetraplegia to use the Internet and other computer applications which brings great benefits in many areas.

Body weight–supported treadmill ambulation is recognised to have both research and clinical applications. Research is still ongoing on this equipment but it is already clinically useful as a training device for persons with minimal ambulatory capability.

Other technological advances include functional electrical stimulation, speaking valves for tracheostomies, and environmental control systems.

The Future of Treatment for SCIs

Clinical trials are constantly ongoing, many using new discoveries developed by the pharmaceutical industry in Europe, North America, and Asia [23]

These include:

(a) Proneuron Phase II trial using autologous incubated macrophages for acute SCI [24]

(b) BioAxone Cethrin trial using the Rho antagonist BA-210 (Cethrin) for acute SCI [25]

(c) University of Calgary trial, using minocycline (an antibiotic with cytokine, free radical, and matrix metalloproteinase inhibition properties) for acute SCI [26]

(d) Aventis HP-184 trial employing this substance in chronic SCI in which some motor function has been preserved—this substance is similar to 4-amino pyridine (4-AP);

(e) the Novartis trial using the anti-NoGo antibody, which reverses the inhibiting effect of NoGo on oligodendrocytes for acute SCI [27]

(f) Geron Corporation trial using implanted oligodendrocyte precursor cells for chronic SCI [28, 29]

(g) Transplantation of fetal and autologous olfactory cells into the spinal cord for chronic SCI in trials in Portugal and China [30, 31]

The Search for a Way to Repair a Damaged Spinal Cord

This has to be the Holy Grail as far as researchers and patients are concerned. Research scientists have developed multiple strategies for studying and repairing the injured spinal cord including both acute and chronic subjects. These efforts have been ongoing and comprise many investigations tackling the issues from different angles. These strategies include  –

How to Reduce the Effects of the Damaged Spinal Cord

This can be accomplished or aided by

Maintaining circulation and oxygenation and creating a favourable milieu (realign and stabilize)

Protecting partially damaged neural tissue by the reduction of neurotoxins and free radicals, eg, by methylprednisolone or glutamate-receptor (eg, AMPA and NMDA) antagonists [32]

Reducing inflammation, eg, by cytokine, Rho, tumor necrosis factor, and interleukin 10 blockers; and by the reduction of apoptosis, eg, by calpains or nitric oxide inhibitors [33]

How to Encourage Neuron Connections Via a Nerve Bridge

This can be done in 3 ways:

1. With Cells:

Schwann cells [34]

Olfactory ensheathing glial cells [35]  

astrocytes [36]

re-engineered fibroblasts or other cell types [37]

2. With Matrix Modifiers: These include

netrins [38]

and neural glues, for example, PEG/synthetic hydrogels [39]

3. With Nerve Grafts: for example, peripheral nerve implants into the spinal cord after the remnants of glials have been removed. [40]

How to Enhance Regeneration and Growth of Axons

Several animal studies have shown promising results. These include

Inhibitor-neutralizing antibody (anti-NoGo) [41]

Neurotrophin 3 [42]

Acidic fibroblast growth factor (AFGF) [42]

Brain-derived neurotrophic factor (BDNF) [43]

Rho antagonists

How to Replace Lost Nerve Cells

Currently, fetal tissue implants [44, 45] and stem cells [46] are both being studied.

How to Inhibit the Formation of Scar/Gliosis

Both decorin [47] and chondroitinases [48] are showing promising results.

How to Reduce Neurocircuit Deficits

Potassium-channel blockers [49, 50]

Sodium-channel blockers [50]

Glutamate-receptor blockers [51]

are all currently being studied to help with this issue. [51]

Conclusion

The enormous amount of research being done to find a ‘cure’ for a damaged spinal cord has led many physicians to expect a breakthrough during their lifetime. Most researchers believe that the solution is not far away as our increasing knowledge of genes and molecules will all help to solve the puzzle. [52]  With ongoing perseverance by the scientists and researchers and support from the consumers, like that of the sadly missed Christopher Reeve, hopefully SCI will cease to be such an injury to be feared and endured.

 

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