The microanatomy of spinal cord injury: A review

Abstract

Spinal cord injury is a highly prevalent condition associated with significant morbidity and mortality. The pathophysiology underlying it is extraordinarily complex and still not completely understood. We performed a comprehensive literature review of the pathophysiologic processes underlying spinal cord injury. The mechanisms underlying primary and secondary spinal cord injury are distinguished based on a number of factors and include the initial mechanical injury force, the vascular supply of the spinal cord which is associated with spinal cord perfusion, spinal cord autoregulation, and post-traumatic ischemia, and a complex inflammatory cascade involving local and infiltrating immunomodulating cells. This review illustrates the current literature regarding the pathophysiology behind spinal cord injury and outlines potential therapeutic options for reversing these mechanisms.

Activation and Regulation of NLRP3 Inflammasome by Intrathecal Application of SDF-1a in a Spinal Cord Injury Model

“…Acute and ongoing chronic local inflammation after SCI appears to be a key element determining the functional outcome and recovery after damage. Thus, the brain innate immune system represented by microglial cells interacts with other CNS cells primarily astroglia, the endothelium, oligodendrocytes, and hampered neurons to provoke inflammatory reactions and the stimulation of pro-inflammatory cytokine networks after SCI [27,28]. Despite many similarities with inflammatory episodes occurring in the brain after neurotrauma, the injured spinal cord reveals distinct anatomical and molecular differences [29].…”

“…Microglia accumulation peaks in the lesion on 3-7 days post SCI throughout the gray and white matter at the epicenter of the injury site [31]. These cells typically produce, after a delay of several hours, pro-inflammatory cytokines such as IL-1b and TNF-a, and recruit other cells to the damaged site [27]. Microglial cells are the primary mediators of the CNS immune defense system and crucial for shaping inflammatory responses.…”

Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spinal cord injury?

“…Edema, necrosis, and ischemia occur in the first few days after trauma as a result of various vascular changes 7. In addition, biochemical signaling cascades are activated, which initiate additional pathological processes 8.…”

The early history of our understanding of the functions of the spinal cord

“…Through clinical correlations between both symptoms and lesions of the spine, along with early manipulative investigations, historical researchers were able to identify the spinal cord as an important conduit for signals to and from the brain. Contemporary researchers [2,[11][12][13][14][15][16][17] have used investigative techniques that have gone beyond surgical manipulation and stimulation to visualize the various components of the central Fig. 1 and cover figure Collage demonstrating physicians who have studied the spinal cord over human history.…”

“…Given the morphological consistency displayed by the spinal cord and the obvious clinical symptoms and syndromes produced from injury to it, the function and actions of the spinal cord were not the subject of conjecture and scientific uncertainty. Contemporary research on the spinal cord has instead focused on microanatomy and manipulation of the spinal cord to treat spinal cord injury [2]. The present review aims to provide an overview of our understanding of spinal cord function through history, and how this historical understanding may be used to construct a framework to guide further research into spinal cord function.…”