Overview
Spinal cord injuries cause myelopathy or damage to nerve roots or myelinated fiber tracts that carry signals to and from the brain. Depending on its classification and severity, this type of traumatic injury could also damage the grey matter in the central part of the cord, causing segmental losses of interneurons and motorneurons. Spinal cord injury can occur from many causes, including:
a) Trauma such as automobile crashes, falls, gunshots, diving accidents, war injuries, etc.
b) Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer.
c) Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurysms, emboli, arteriosclerosis.
d) Developmental disorders, such as spina bifida, meningomyolcoele, and other.
e) Neurodegenerative diseases, such as Friedreich’s ataxia, spinocerebellar ataxia, etc.
f) Demyelinative diseases, such as Multiple Sclerosis.
g) Transverse myelitis, resulting from stroke, inflammation, or other causes.
h) Vascular malformations, such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma, cavernous angioma and aneurysm.
The Location of the Injury Determining the exact level of injury is critical in making accurate predictions about the specific parts of the body that may be affected by paralysis and loss of function. The symptoms observed after a spinal cord injury differed by location (refer to the spinal cord map on the right to determine location). Notably, while the prognosis of complete injuries is generally predictable, the symptoms of incomplete injuries span a variable range. Accordingly, it is difficult to make an accurate prognosis for these types of injuries. Cervical injuries Cervical (neck) injuries usually result in full or partial tetraplegia (Quadriplegia). However, depending on the specific location and severity of trauma, limited function may be retained.
a) C3 vertebrae and above: Typically results in loss of diaphragm function, necessitating the use of a ventilator for breathing.
b) C4: Results in significant loss of function at the biceps and shoulders.
c) C5: Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands.
d) C6: Results in limited wrist control, and complete loss of hand function.
e) C7 and T1: Results in lack of dexterity in the hands and fingers, but allows for limited use of arms.
C7 is generally the threshold level for retaining functional independence Thoracic injuries Injuries at or below the thoracic spinal level result in paraplegia. Function of the hands, arms, neck, and breathing is usually not affected.
a) T1 to T8: Results in the inability to control the abdominal muscles. Accordingly, trunk stability is affected. The lower the level of injury, the less severe the effects.
b) T9 to T12: Results in partial loss of trunk and abdominal muscle control. Lumbar and Sacral injuries The effects of injuries to the lumbar or sacral regions of the spinal cord are decreased control of the legs and hips, urinary system, and anus.
Conventional Treatment
Treatment options for acute, traumatic non-penetrating spinal cord injuries include the administration of a high dose of an anti-inflammatory agent, methylprednisolone, within 8 hours of injury. This recommendation is primarily based on the National Acute Spinal Cord Injury Studies (NASCIS) I and II. However, in a third study, methylprednisolone failed to demonstrate an effect in comparison to placebo. Additionally, due to increased risk of infections, the use of this anti-inflammatory drug after spinal cord injuries is no longer recommended. Presently, administration of cold saline acutely after injury is gaining popularity, but there is a paucity of empirical evidence for the beneficial effects of therapeutic hypothermia. Conventional treatment can not recover the function of spinal cord.
The goal of rehabilitation is to make the remaining function to compensate the function lost such as lower limbs paralysis or disabling in working or moving, and to move with upper limbs or walk with crutch so as to compensate the function of lower limbs. Rehabilitation shall include exercises in moving, walking, wheelchair, muscle, sitting and attitude. Despite the devastating effects of the condition, commercial funding for research investigating a cure after spinal cord injury is limited, partially due to the small size of the population of potential beneficiaries. Despite this limitation, a number of experimental treatments have reached controlled human trials.
There are many similarities between these conditions of the CNS and spinal cord injuries, thus increasing the potential for discovery of a treatment after spinal cord injuries. Traditional treatment can not recover the function of spinal cord. The goal of rehabilitation is to make the remaining function to compensate the function lost such as lower limbs paralysis or disabling in working or moving, and to move with upper limbs or walk with crutch so as to compensate the function of lower limbs. Rehabilitation shall include exercises in moving, walking, wheelchair, muscle, sitting and attitude.
Limitations of Conventional Treatment
A number of drugs commonly used for a variety of clinical indications have been found recently to have substantial neuroprotective properties, raising the potential for rapid translation into human clinical trials of spinal cord injury (SCI). In this study we compared the neuroprotective efficacy of erythropoietin and a derivative of it, darbepoetin, in an acute model of thoracic SCI. Sprague-Dawley rats were randomized to receive erythropoietin (5000 IU/kg), darbepoetin (10 mug/kg), or saline, as a single intravenous injection 1 h after a thoracic contusion SCI. The animals were evaluated for behavioral recovery over 6 weeks, which included BBB locomotor testing, horizontal ladder testing, video-analysis of gait, and hindlimb monofilament sensory testing. At 6 week post-injury, the spinal cords were evaluated histologically to measure white and grey matter sparing at and around the epicenter of injury. We found that neither erythropoietin nor darbepoetin led to improved behavioral recovery over saline controls, with no significant differences observed in BBB scores, BBB subscores, footfall errors on horizontal ladder testing, width of hindlimb base of support, or threshold for paw withdrawal on sensory testing. Furthermore, no differences were observed in grey or white matter sparing between the three experimental groups. Using doses of erythropoietin and darbepoetin that other investigators have reported to be beneficial in SCI and stroke models, we were unable to demonstrate a neuroprotective effect when administered 1 h after injury. Further preclinical investigation is necessary to refine the treatment strategy of using erythropoietin or darbepoetin in acute spinal cord injury.
Stem Cell Treatment
Traditionally, people believe that nerve cells are the cells which cannot be regenerated. However, new research has found that nerve cells can be regenerated, as transplanted neural stem cells migrating to the damaged location to survive and proliferate into neurons, astrocyte and oligodendroglia. Following the regeneration of neuraxon and medullary sheath, new functional neuraxon connection can be established. The new medullary sheath can be formed from both the remained and the newly generated nerve fibers to maintain the functional integrity of nerve fibers and to recover the function of damaged nerves. The sequela of spinal cord injury can be reduced and improved when rehabilitation is taken to promote the growth and repairing role of transplanted neural stem cells, therefore, improving life quality of the patients.
Indications of Stem Cell Treatment
Improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities. -Respiratory complications are often an indication of the severity of spinal cord injury abilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support. Acute Spinal Cord Injury: The use of methylprednisolone in high doses has resulted in improvement in motor and sensory recovery. Treatment should begin within 8 hours of injury.
Advantages of Stem Cell Treatment
Because neurons (nerve cells) in the central nervous system (the brain and spinal cord) do not repair or replace themselves after being injured, researchers are investigating whether transplanting cells into an injured area can restore function. Stem cells are a potential replacement for injured neurons. One of the many challenges for researchers is obtaining cells that will function as neurons in the brain or spinal cord. Because a person t have spare neurons for transplantation, efforts are being made to find other cells that can be transformed into neurons. One potential source is cells from human embryos. Less than a week after conception cells in an embryo begin to that is, they begin to form specific types of cells, such as bone cells, red blood cells, heart muscle cells, and so on. Stem cells are simply cells that can differentiate into other types of cells. Early in the life of an embryo stem cells have the potential to differentiate into the more than two hundred types of cells in a human body. There are other kinds of stem cells, including stem cells in adults, which can differentiate into a more limited number of types of cells. Embryonic stem cell research has been highly controversial. Using embryonic stem cells for transplantation is controversial because it is necessary to first create human embryos to produce the stem cells and then kill the embryos in the process of the stem cells. Opponents of the process contend that it is unethical or immoral to create and then kill any form of human life for the purpose of harvesting stem cells. Proponents of stem cell transplantation either claim that embryos created in a laboratory have no value or significance apart from producing stem cells or that the end of helping injured or ill people justifies the means of creating and then killing human life.
Stem Cells, may be pluripotent or multipotent, are important for living organisms for many reasons. Pluripotent stem cells can give rise to any type of cell in the body except those needed to support and develop a fetus in the womb. Stem cells that can give rise only to a small number of different cell types are called multipotent.
Neural Stem Cells (NSCs) are capable to self-renew and differentiate into neurons. When transplanted into the damaged site of brain, NSCs are able to differentiate into corresponding neural cells at the focus, and produce various neurotrophic factors. As the results, the damaged cells will be replaced, the nerve loop will be reconstituted and the degeneration of nerves or semi-apoptotic cells will be inhibited.
The advantages of the stem cells transplantation are followed:
- Relatively safe compare with most of the conventional treatments
- No immunological rejection, since stem cells have very low immunity
- Not affected by the blood-brain barrier, because stem cells are directly injected into the damaged tissues.
Advantages of Fetal Stem Cell Treatment
In the World Stem Cell Therapy Center, the stem cells used for most of our therapies are the Fetal Stem Cells (FSCs). FSCs treatment has a number of advantages compared with the transplantation of any other types of stem cells, i.e. adult, cord blood and animal stem cells.
- Avoid the histocompatibility problems
Histocompatibility has always been regarded as stumbling-block of transplantology, causing rejection of transplanted organs, bone marrow and cord blood stem cells, etc., thus requiring additional special methods aimed at suppression of the recipient’s immune system. With fetal stem cell transplantation, it is possible to avoid any side effects related to histocompatibility and ensure engraftment and proliferation of the administered cells, as well as their functioning in the body for many months and even years without immunosuppression.
- Ensure both target and systemic effects
In addition to targeted cell effects predicted and described by researchers, fetal stem cell transplantation can exert powerful systemic effects related to psychoemotional sphere, physical activity, immune system, homeostasis and functioning of internal organs, achieved via regulatory systems of the recipient’s body. Each type of stem cells produces certain specific tissues. Human regulatory systems, controlling the transplanted cells, guide the development and specialization of those cells in compliance with body needs, thereby ensuring precise specialization of clinical effects. Only natural tissues are used without any genetic engineering or cloning process for the cell cultures. The effects of the FSCs treatments are significantly different from most other medicinal treatments. Within 1 2 months after transplantation, early clinical effects of FSCs transplantation can be observed. The long-term effects of the FSCs treatments can be 6 3 years. In some cases, the engraftment will stay for lifetime.
