Recent Advances in the Treatment of Spinal Cord Injury

Arch Bone Jt Surg, 2024 · DOI: 10.22038/ABJS.2023.73944.3424 · Published: June 1, 2024

Spinal Cord Injury Pharmacology Regenerative Medicine & Stem Cells

Simple Explanation

Spinal cord injury (SCI) is a complex condition that causes irreversible damage to individuals, families, and society. Recent advances in managing and rehabilitating SCI have significantly improved axonal regeneration, remyelination, and neuronal plasticity of the injured spinal cord. However, no specific and complete treatment has been reported for SCI in humans due to its neurological complexity. The failure to treat SCI is due to the inherent neurological complexity and the structural, cellular, molecular, and biochemical characteristics of the injury. This review elucidates the causes of spinal cord injury from a molecular and pathophysiological perspective and describes the complexity and drawbacks of neural regeneration that lead to failure in SCI treatment. Recent advances and cutting-edge strategies in most areas of SCI treatment are presented, covering topics such as pharmacological therapies, surgical interventions, acupuncture, exercise, massage therapy, cell therapy, tissue engineering strategies, advanced three-dimensional bioprinting, emerging biochemical, cellular, and molecular strategies, and combination therapy.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Key Findings

1
The pathophysiology of SCI consists of a two-phase process: the primary mechanical injury and the subsequent cascade of auto-destructive damages. This cascade leads to inflammation, hemorrhage, demyelination, axon disruption, apoptosis, and necrosis.
2
Therapeutic strategies for SCI include medicinal therapy, surgery, and rehabilitation. Spinal decompression surgery within the first 24 hours after injury improves six-month outcomes. Pharmacological treatments such as neuroprotective and anti-inflammatory agents are recommended during the primary stages of injury and inflammation.
3
Cell therapy harmonizes multiple mechanisms such as immunomodulation and neuroprotection by trophic factor release, as well as axon and myelin regeneration to promote functional recovery after SCI. Regenerative cell therapy uses various cell sources including embryonic stem cells (ESCs), hematopoietic stem cells (HSC), mesenchymal stem cells (MSC), neural stem cells (NSCs), and induced pluripotent stem cells (iPSCs).

Research Summary

Spinal cord injury (SCI) is a complex and incurable condition causing significant damage. While advancements in managing SCI have improved, a complete treatment for humans remains elusive due to the inherent neurological complexity and various characteristics of the injury. Current treatments, including medicinal therapy, surgery, and rehabilitation, have limitations. Emerging strategies focus on biochemical, cellular, and molecular approaches, such as glial scar modulation, cell reprogramming, growth factor delivery, and biomolecule intervention to minimize tissue damage and improve neurological functions. Combination therapy, integrating established and novel strategies, holds promise for overcoming individual treatment limitations and improving SCI management. Clinical trials play a crucial role in advancing treatment options and enhancing the quality of life for SCI patients.

Practical Implications

Clinical Practice

Healthcare professionals should consider combination therapies that integrate established and novel strategies to improve outcomes in SCI management.

Research

Further research is needed to develop targeted therapies that address the secondary damage and promote neuroprotection and regeneration in patients with spinal cord injuries.

Drug Development

Drug development should focus on novel pharmacological agents, growth factors, and biomolecules that can modulate immune responses and promote axonal regeneration and functional recovery.

Study Limitations

1
Treatments with only one management method seem inefficient.
2
The failure of healing after SCI involves several factors, containing chronic local inflammation, biochemical cues, and the release of anti-regenerative factors.
3
Prescriptions, surgeries, and other mentioned management are based on previous experiences with patient or animal samples that only represent a division of the current capabilities for SCI treatment as an intricate disease.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury