SPINAL CORD INJURIES

SPINAL CORD INJURIES

SPINAL CORD Injury Information
National Institute of Neurological Disorders
Canadian Spinal Research Home Page
The American Paralysis Association
DEALING WITH SCI
Spinal Cord Injury
National Spinal Cord Injury Statistical Center
Glossary of SCI Terms
Spinal Cord Research Centre
Spinal Cord Injury Support
The National Spinal Cord Injury Association
Spinal Cord Injury Hotline

Current Treatment for Human Spinal Cord Injury

Photo of Wise Young

  Wise Young, M.D.,
  treats many patients
  with spinal cord
  injuries.

What is the best treatment for someone who has just suffered a spinal cord injury? In a recent conversation, Wise Young, who heads the Neurosurgery Research Laboratory at New York Medical Center in New York City, listed the following steps. Young has an 18-year-old daughter and he described what he would do if she were injured.* (The following information is not to be considered as a guide for treating patients with spinal cord injuries. Instead, it is to be used only as a source of information.)

1. GIVE METHYLPREDNISOLONE

"I would move heaven and earth to make sure that she received methylprednisolone as soon as possible," said Young. The latest studies of the drug, which the federal Food and Drug Administration approved as an emergency treatment for spinal cord injury in 1990, show that it is best to give methylprednisolone within three hours after a spinal cord injury occurs. Patients can benefit from treatment later than that -- up to eight hours after the injury -- but "there's a real need to give it immediately," says Young.

Researchers do not know exactly how methylprednisolone helps injured spinal cord tissue to recover, but they speculate that the drug has at least two main effects. One is that methylprednisolone, which is a synthetic steroid, suppresses immune responses throughout the body. This can be beneficial for patients who have spinal cord injuries because vigorous inflammatory responses at the site of injury may worsen its impact.

The second way in which methylprednisolone works may be to block the formation of free radicals. These charged, highly energetic ions can disrupt the membranes of cells that were not initially injured. So the overall effect of methylprednisolone for people with spinal cord injuries seems to be protective: The drug apparently prevents destructive inflammatory responses at the site of injury and it also prevents the formation of free radicals.

Researchers are continuing to study the effects of methylprednisolone and to design drugs that capture its benefits without causing unwanted side effects, such as too much immune suppression throughout the body.

2. REMOVE ANY BONE THAT IS COMPRESSING THE SPINAL CORD.

Next, Young would be certain that his daughter received a special operation called "surgical decompression of the spinal cord." In most people who have spinal cord injuries,the spinal cord is compressed, not cut. Thus, the rationale for using surgery to decompress the injured cord is to relieve any pressure from surrounding bone. Pressure on spinal cord tissue can cause mechanical damage as well as cutting off the supply of blood and oxygen.

But the surgery is controversial, says Young, and it is also a difficult and expensive procedure. Young recommends doing the surgery as soon as possible. But he acknowledges that "there are simply no guidelines" for neurosurgeons about when and under what circumstances they should the surgery.

3. STABILIZE THE SPINE

Young also recommends surgery to stabilize the spine. Stabilization should prevent further compression or twisting of the spinal cord and it should also allow the injured person to be hoisted upright in a specialized bed frame as soon as possible. "The rehabilitation period is much longer if the patient remains lying down," says Young.

4. CONSIDER SCHWANN CELL IMPLANTS AS EXPERIMENTAL THERAPY.

Of all the experimental treatments for spinal cord injury that researchers are investigating, Young would most seriously consider a Schwann cell transplant.

Schwann cells are not normally present in the central nervous system (CNS), which includes the brain and spinal cord. Instead, Schwann cells occur in the peripheral nervous system (PNS), which serves the rest of the body. Their function is to produce many layers of a membranous, fatty wrapping called myelin that surrounds nerve cell axons, the threadlike fibers of nerve cell cytoplasm that conduct electrical impulses from a nerve cell to its target. Myelin increases the speed of nerve cell impulses and is necessary for the normal functioning of most nerve cells in the brain and spinal cord.

Researchers consider using implants Schwann cells to help repair damaged spinal cord axons because they may act as a physical bridge, supply nourishing chemical factors that encourage regeneration, and allow the normal functioning of undamaged or regenerated axons. In humans, the procedure would involve removing a small amount of the patient's own peripheral nerve tissue, isolating Schwann cells from the tissue, growing them in plastic culture dishes in an incubator, then implanting the cultured Schwann cells into the site of spinal cord injury.

The strategy of using purified Schwann cells or bits of PNS tissue to repair injured brain and spinal cord axons has emerged from many decades of research on animals. Researchers have learned that by transplanting PNS tissue into the site of an injury in the brain or spinal cord, they can sometimes induce injured CNS axons to regrow. (In fact, the Swedish investigator, Lars Olson, heads a team of researchers who recently reported using tiny bridges of PNS tissue to repair the spinal cords of adults rats. Link to: "Swedish Researchers Combine Treatments To Repair Severed Rat Spinal Cords")

The transplanted PNS tissue may enhance the regeneration of brain or spinal cord axons for several reasons. PNS tissue -- which includes Schwann cells -- contains nourishing chemical factors called neurotrophins that stimulate axons to regrow. Also, tissue from the peripheral nervous system lacks inhibitory factors that are normally present in CNS tissue and that seem to prevent axon regrowth after an injury. Additionally, the noncellular material -- known as the extracellular matrix -- that surrounds nerve cells has a different chemical composition in the PNS than does the corresponding extracellular material in the CNS. (See "Why Don't The Brain And Spinal Cord Repair Themselves?'] All of these chemical differences -- the combinations of neurotrophins, inhibitory factors, and the composition of the extracellular matrix -- make the peripheral nervous system a more hospitable environment than the central nervous system for axonal regeneration.

Finally, transplanted Schwann cells should help maintain the myelin wrapping that is so essential to the normal function of nerve cells. "Myelin turns out to be a very major factor in spinal cord injury," says Young. Often-- a week or two after a spinal cord injury -- a wave of cell suicide occurs in the CNS cells that make myelin, which are called oligodendrocytes. As a result, the myelin wrapping around the axons of spinal cord nerve cells becomes very thin, which makes the axons incapable of transmitting nerve impulses fast enough to accomplish their normal functions. If another source of myelin -- from transplanted Schwann cells -- could be supplied, the intact and regenerating nerve cells might function more normally.

5. BEGIN REHABILITATION AS SOON AS POSSIBLE.

Rehabilitation therapy for patients with spinal cord injuries takes many forms, depending on the site and extent of injury and the age and medical condition of the patient.

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Footnote:

* There are no national guidelines for treating acute spinal cord injuries, although many emergency medical teams administer methylprednisolone and stabilize the spine. The treatments described here should not be interpreted as guidelines for medical practitioners. Rather, they are intended to inform readers about existing treatments and potential therapies that may some day be available.

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