Recovery and Regeneration after Spinal Cord Injury: A Review and Summary of Recent Literature

Abstract

Introduction: Spinal cord injury (SCI) often results in significant neurologic dysfunction and disability. An annual incidence of 15 to 40 traumatic SCI cases per million population has been reported worldwide, and a conservative estimate for Singapore would be 23 cases per million. With continued improvements in medical care, an increasing prevalence of SCI patients is expected, with corresponding need for comprehensive rehabilitation services led by specialist rehabilitation physicians. Methods: A literature search, review, and summary of findings of recent studies relating to factors associated with recovery, as well as interventions for rehabilitation and promotion of healing of the injured spinal cord was performed. Conclusions: Many SCI patients show improvements in motoric and neurologic level, but those with complete injuries have poor chance of improving American Spinal Injury Association (ASIA) scores. SCI of violent aetiology tends to be more neurologic complete, and those without sacral sparing less likely to improve. Older patients generally do well in activities of daily living. Women have better motor score improvement, although men have better Functional Independence Measure (FIM) scores generally. Electrodiagnostic tests such as somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) can help with prognostication, as can imaging techniques such as magnetic resonance imaging (MRI). Immediate surgery for spinal decompression may improve recovery, but whether routine surgery after SCI improves function remains unclear, as does the timing. Methylprednisolone and similar agents appear to help limit secondary injury processes. Rehabilitation interventions such as functional electrical stimulation (FES) and body-weight supported treadmill ambulation training may be effective, as may neural-controlled prostheses and devices. Substances that promote repair and regeneration of the injured spinal cord such as GM-1, 4-AP, BDNG, GDNF, Nogo and MAG-inhibitors, have been studied. Transplanted tissues and cells, such as blood macrophages, bone marrow transplant with GM-CSF, olfactory ensheathing cells, fetal tissues, stem or progenitor cells, have been reported to produce neurological improvements. Key words: Prognosis, Regeneration, Rehabilitation, Spinal cord injuries

Peptide OM-LV20 promotes structural and functional recovery of spinal cord injury in rats

“…Lipid peroxidation is mediated by free radicals in the acute phase of SCI and has an important effect on secondary injury 27 . As the nal product of lipid peroxidation, MDA levels can indirectly re ect the severity of acute phase cell injury 28 .…”

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

“…On the other hand, no statistically significant association was noted between completeness of neurological injury and recovery of bowel and bladder function specifically (regardless of recovery of lower extremity neurological function). This discrepancy seems to be due to a propensity for complete injuries to recover bowel and bladder function without recovering extremity function [ 6 , 16 , 23 ].…”

Of Rehabilitation Medicine and the Rehabilitation Physician

“…In this issue of the Annals, which has been devoted to Rehabilitation Medicine, the focus is on review articles of common conditions treated by the Rehabilitation Physician. [1][2][3][4][5][6][7][8][9] These include traumatic brain injury rehabilitation in paediatric and adult patients, evidence on use of Botulinum toxin in treatment of spasticity, recovery and regeneration treatment after spinal cord injury, new therapies in stroke rehabilitation and myofascial pain.…”