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Spinal Cord Injury Explained – Mad Spaz Club

By Dr. Matthew Watson

Injury to the spinal cord can be caused by acute (sudden) or chronic (developing) trauma as well as medical conditions. Frequent causes of chronic compression injuries are herniated disks and primary or secondary tumors. Compromised blood perfusion, the delivery of nutritive arterial blood to capillary bed, as in anterior spinal cord syndrome can also be severely detrimental to spinal cord function. However the most damaging Spinal Cord Injury is one of acute trauma resulting in permanent paralysis.

Traumatic spinal cord injury have been classified into five categories by the American Spinal Injury Association and the International Spinal Cord Injury Classification System:

Spinal cord injury where no motor or sensory function remains in the sacral segments S4-S5.

Spinal cord injury sensory but not motor function remains below the neurological level and includes the sacral segments S4-S5. Typically a transient phase and if the person recovers any motor function below the neurological level, theyare considered motor incomplete and classified C or D.

Spinal cord injury where motor function remains below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity.

Spinal cord injury where motor function exists below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.

Where motor and sensory scores are normal. It is possible to have spinal cord injury and neurological deficits with completely normal motor and sensory scores.

The annual incidence rate of spinal cord injury varies from country to country, ranging from 15 to 71 per million (/m). In 2008 the incidence of spinal cord injury in the United Kingdom around 13 /m, Australia 14 /m, Canadi 35 /m, China 65 /m and the United States 35 /m per year. This suggests around 40 per million or 52,000 spinal injuries occur every year globally.

Of the 12,000 new cases of paraplegia and quadriplegia that occur in the United States each year 4,000 patients die before reaching hospital. Causes of acute spinal cord injury include motor vehicle accidents, work-related accidents, recreational accidents, falls and violence (shootings and stab wounds).

Paralysis occurs our times as often in males as females where about 60% of victims are under 30 years of age and 5% under 13 years of age (the pediatric age group). Falls from a height greater than their own is the largest cause of spinal trauma amongst the pediatric age group. A long-term outcome study of patients aged 25 to 34 who had suffered acute traumatic SCI before the pediatric age showed an employment rate of 54% while the employment rate in the general population for the same age group was 84%.

Limitation or complete loss of the capability to achieve economic independence following SCI combined with additional medical costs causes severe economic hardship for many living with paralysis and their immediate family. Further limitations to living a full social life are architectural barriers, buildings only accessible by stairs and a lack of ramps on sidewalks for example.

Increased awareness through education has played a key role in resolving these barriers and those created by negative or overprotective attitudes of healthy, non-injured people toward persons with spinal cord injury. When persons with spinal cord injury cannot fully participate society suffers. Not only are ethical standards, artistic and financial contributions to society lost, huge expenses for specialised lifelong care are incurred.

80% of SCI occur in people under the age of 30. The average life-time cost of thoracic paraplegia is $1.25 million and high level cervical quadriplegia such as those on ventilators $25 million USD. In 1990 the cost for acute and long term care of surviving spinal cord injury victims was estimated at $4 billion in the United States alone.

Road traffic accidents 45%

Domestic and industrial accidents 34%

Sporting injuries 15%

Self harm and criminal assault 6%

The first known description of acute spinal cord trauma and resulting neurological deficits was in the Edwin Smith papyrus which is believed to be more than 3,500 years old. In this ancient Egyptian document Smith accurately described the clinical symptoms and traumatic effects of quadriplegia (tetraplegia) anailment not to be treated. An indication of the feelings helplessness medical practitioners suffered at the time, a doctors value measured by the extent of cure achieved.

No strategies ensuring longterm survival for patients with spinal cord injury existed. A view which prevailed well into the early 1900s. In the First World War the mortality rate for those with a spinal cord injury was 95%, mainly attributed to urinary sepsis and complications from pressure sores. Less than 1% survived for more than twenty years.

During World War II the number of casualties from spinal cord injuries both military and civilian increased dramatically in Europe. Specialized hospital units known as peripheral nerve centers developed between the wars in Germany and the United States demonstrating the advantages of concentrating special needs patients under specialized care. Great importance was placed on the unique opportunities offered by these specialized units. Gaining new insight in the natural course of the disease and further development of new therapeutic strategies.

Building on those experiences, specialized spinal cord injury units started opening throughout England in the 1940s. Mortality rates from a spinal cord injury were recorded at 35% in the 1960s. Today nearly every capital city operates an acute care spinal unit.

Dr. Ludwig Guttmann and his colleagues at the Spinal Cord Unit of Stoke Mandeville Hospital developed new treatment approaches including frequent repositioning of paralyzed patients to avoid developing bedsores, a potential source of sepsis and intermittent sterile catheterization to prevent urinary sepsis. The success in patient survival was dramatic enough to require development of completely new strategies for social reintegration of patients with spinal cord injury. Adapted workplaces and wheelchair accessible housing championed in the 1940s and 1950s by the English Red Cross has today become an integral component in the framework of social politics in most industrialized countries. Respiratory complications are now the leading cause of death in patients admitted with SCI. Secondary are heart disease, septicemia (blood poisoning), pulmonary emboli (blood clot in lungs), suicide, and unintentional injuries.

Dr. Guttmann and his colleagues viewed physical rehabilitation as the basis of social reintegration both physically and psychologically. Supporting the idea of athletic competition in disciplines adequate and adapted to the physical capacity of their patients. Starting with two teams a competition in 1948 paralleling the Olympic Games in England, the idea of competitive sports for the paralyzed developed rapidly.

In 1960 the first Paralympic Games were held in Rome. The Paralympic games were held in the same year as the Olympic Games for the able-bodied using the same facilities, a tradition that has been followed ever since. The idea of competitive sports was extended to include people with a multitude of physical handicaps other than spinal cord injury emerging as the Paralympics we know today.

In many countries initiatives have risen at communal and national levels with the intent to decrease the incidence of spinal cord trauma and offer support and advice to both those with spinal cord injuries and their families. Many generously offer financial support for scientific and clinical research.

The prevention oriented Think First initiative, Canadian-based CORD and Wheels in Motion, the Christopher Reeve Paralysis Foundation, the U.K. Spinal Cord Trust, and the Paralyzed Veterans of America all maintain informative web sites with valuable information on the subject of spinal cord injury.

Although the overall incidence of SCI has not noticeably decreased the severity of injuries has deceased overall. Fewer now suffer complete injuries and survival rates have increased. This is mostly attributed to improvements in prehospital care including widespread instruction of first aid principles as well as the introduction of spinal cord immobilization and administration of advanced medicines during rescue and transport. Increased public awareness of risk factors leading to head trauma and spinal cord injury, the introduction of mandatory use of safety belts and installation of air bags in modern vehicles has also served to decrease trauma severity.

Until recently research suggested once spinal cord trauma had occurred nothing could be done to alter the natural course of developing pathology, that damage to the central nervous system was permanent and repair impossible. At the beginning of the twenty-first century this belief came to change in the minds of scientists, clinicians, patients and their families. Research laboratories around the world adopted two new approaches:

1. Prevention of secondary injury and repair of manifest damage. The term secondary injury describes the observation that central nervous system structures that survived the primary mechanical trauma die at a later point in time due to deterioration of the milieu (nerve ending sheath) at the site of injury.

2. The amount and severity of secondary injury damage can be significantly larger than that of the primary injury. Researchers focused on identification of substances and therapeutic methods that help minimize secondary injury effects. In the field of cell biology, isolation and manipulation of specific cell types is being undertaken in effort to induce certain cell types, including stem cells and olfactory ensheathing cells to help repair damaged central nervous system structures.

Clinical research continues to improve outcomes for those with a spinal cord injury, such as stimulators for bladder control, orthopedic correctional procedures and physical mobilization. Integration of biomedical research like pattern generators, mechanics and kinetics of movement with the latest developments in computer science and engineering has given rise to neuronal networks. Neuroprostheses are being developed which enable paraplegics to move about and walk.

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Clinical trial of stem cell therapy for traumatic spinal …

By Dr. Matthew Watson

Mayo Clinic is enrolling patients in a phase 1 clinical trial of adipose stem cell treatment for spinal cord injury caused by trauma. The researchers already have approval from the Food and Drug Administration for subsequent phase 2A and 2B randomized control crossover trials.

Participants in the phase 1 clinical trial must have experienced a trauma-related spinal cord injury from two weeks to one year prior to enrollment. They will receive intrathecal injections of adipose-derived mesenchymal stem cells. No surgery or implantable medical device is required.

"That is the most encouraging part of this study," says Mohamad Bydon, M.D., a consultant in Neurosurgery specializing in spinal surgery at Mayo Clinic in Rochester, Minnesota, and the study's director. "Intrathecal injection is a well-tolerated and common procedure. Stem cells can be delivered with an implantable device, but that would require surgery for implantation and additional surgeries to maintain the device. If intrathecal treatment is successful, it could impact patients' lives without having them undergo additional surgery or maintain permanently implantable devices for the rest of their lives."

To qualify for the trial, patients must have a spinal cord injury of grade A or B on the American Spinal Injury Association (ASIA) Impairment Scale. After evaluation at Mayo Clinic, eligible patients who enroll will have adipose tissue extracted from their abdomens or thighs. The tissue will be processed in the Human Cellular Therapies Laboratories, which are co-directed by Allan B. Dietz, Ph.D., to isolate and expand stem cells.

Four to six weeks after the tissue extraction, patients will return to Mayo Clinic for intrathecal injection of the stem cells. The trial participants will then be evaluated periodically for 96 weeks.

Mayo Clinic has already demonstrated the safety of intrathecal autologous adipose-derived stem cells for neurodegenerative disease. In a previous phase 1 clinical trial, with results published in the Nov. 22, 2016, issue of Neurology, Mayo Clinic researchers found that therapy was safe for people with amyotrophic lateral sclerosis (ALS). The therapy, developed in the Regenerative Neurobiology Laboratory under the direction of Anthony J. Windebank, M.D., is moving into phase 2 clinical trials.

Dr. Windebank is also involved in the new clinical trial for people with traumatic spinal cord injuries. "We have demonstrated that stem cell therapy is safe in people with ALS. That allows us to study this novel therapy in a different population of patients," he says. "Spinal cord injury is devastating, and it generally affects people in their 20s or 30s. We hope eventually that this novel therapy will reduce inflammation and also promote some regeneration of nerve fibers in the spinal cord to improve function."

Mayo Clinic's extensive experience with stem cell research provides important guidance for the new trial. "We know from prior studies that stem cell treatment can be effective in aiding with regeneration after spinal cord injury, but many questions remain unanswered," Dr. Bydon says. "Timing of treatment, frequency of treatment, mode of delivery, and number and type of stem cells are all open questions. Our hope is that this study can help answer some of these questions."

In addition to experience, Mayo Clinic brings to this clinical trial the strength of its multidisciplinary focus. The principal investigator, Wenchun Qu, M.D., M.S., Ph.D., is a consultant in Physical Medicine and Rehabilitation at Mayo Clinic's Minnesota campus, as is another of the trial's investigators, Ronald K. Reeves, M.D. Dr. Dietz, the study's sponsor, is a transfusion medicine specialist. Also involved is Nicolas N. Madigan, M.B., B.Ch., BAO, Ph.D., a consultant in Neurology at Mayo Clinic's Minnesota campus.

The study team is in discussions with U.S. military medical centers to enroll patients, and discussing additional collaboration with international sites, potentially in Israel or Europe, for future phases of the study.

"At Mayo Clinic, we have a high-volume, patient-centered multidisciplinary practice," Dr. Bydon says. "That allows us to do the most rigorous scientific trial that is in the best interests of our patients."

Mayo Clinic. Adipose Stem Cells for Traumatic Spinal Cord Injury (CELLTOP). ClinicalTrials.gov.

Staff NP, et al. Safety of intrathecal autologous adipose-derived mesenchymal stromal cells in patients with ALS. Neurology. 2016;87:2230.

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Stem Cell Therapy for Spinal Cord Injury- Treatment for …

By Dr. Matthew Watson

Stem Cell Therapy for Spinal Cord Injury-Spinal cord injury is one of the progressively degenerating, crippling disorders attributing towards the dislocation of bones and vertebrae; which is a general result of trauma and/or injury.

The accidental injury generally damages connecting nerves internally; in order to halt the back and forth communication between brain and rest of the body parts. This communication gap is the primary cause of partial or complete loss of movement, paralysis as well as numbness. Apparently, many times it has also been evident that spinal cord may get affected not because of the injury but because of different types of nerve infection; which if ignored for a longer time, may allow unusual bleeding in between the spaces around the spinal cord. Some of the common forms of these notable infections are spinal stenosis, spina bifida, etc.

A person with a potential threat to severe spinal cord damage should be hospitalized for an intensive care unit immediately. Stabilization of blood pressure, lung function, and prevention of further damage to the spinal cord; should be emphasized with immediate effect. Other injuries are as well to be looked at; for an accidental damage.

Experts may prescribe some routine tests, in order to detect the extent of injuries. These tests can be

Classification of SCI is generally based on the extent of pain and loss of movement, associated with the damage. Moreover, when the damage is associated with neuronal loss, nerve locations and anumber of nerves that have been damaged can as well be referred to classify spinal cord injury.

The recovery period for patients suffering from spinal cord injury is dependent upon the level of injury, muscular strength and the type of injury; but in general, the notable recovery period can be anytime between 4-6 months.

Through conventionally demonstrated medicines, it is generally impossible to completely cure spinal cord damage or paralytic aftereffects of injury. In fact, the anti-inflammatory medicines that have been prescribed conventionally can affect other vital organs of the body, due to continuous hormonal modifications. Although with the advent of stem cells through the science of regenerative medicine has proven to be very helpful in offering a definite cure for SCI and other orthopedic related illnesses. The potential ability of these stem cells to be differentiated into neurons has been well studied and confirmed through different scientific literature and the same hypothesis can be applied to treat and restore back the functional attributes of damaged spinal cord.

Thus, stem cells and their regenerative powers can potentially work to solve the internal mysteries of spinal cord injury; but the extent of recovery and therapeutic outcome are still the challenges that are being faced by the medical fraternities.

For further queries regardingstem cell therapy for spinal cord injury, feel free to connect us at+91-96543 21400 or info@advancells.com. You can also connect us through Advancells Enquiry.

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Adult Stem Cells Treat Spinal Cord Injury | News | Spinal …

By Dr. Matthew Watson

Laura Dominguez-Tauer is a living, breathing example of what it takes to overcome adversity. An oil spill on a San Antonio freeway is blamed for the car crash that sent Laura and her brother directly into a retaining wall in 2001. As she lay tangled in the middle of the car, she heard a paramedic say, get a neck brace, she has a broken neck.

I didnt feel anything. I couldnt move my arms, I couldnt move my hands,

Laura was paralyzed from the neck down. I didnt feel anything. I couldnt move my arms, I couldnt move my hands, Laura said.

While others might have given up, Laura and her family started immediately searching for answers. They learned about adult stem cells and the promising results for spinal cord injury patients. In 2010, Laura joined a handful of other spinal cord patients and received an adult stem cell transplant. The transplant was a success.

Laura says, Before the stem cell procedure, I wasnt able to move very much. And then after the procedure Im able to get up. Im able to stand and walk around a little bit with help. The stem cell procedure made my upper body a lot stronger. I can feel my entire body now.

Laura went to work making herself stronger. Through physical therapy and a lot of hard work, she grew stronger and stronger. Instead of feeling sorry for herself, she opened a gym called Beyond the Chair. We opened Beyond the Chair to help people with any type of neurological disability whether its spinal cord injury, traumatic brain injury, strokes. We dont turn anybody away. Were going to help people.

In 2010, she met a young man, fell in love and was married. Then came a big surprise. I found out I was pregnant in April of 2016 and I was in disbelief, says Laura. We heard his heartbeat for the first time, and it was kind of like, oh my gosh, this is such a dream come true, its a miracle.

Young Joshau, named after his father, is what Laura is focused on now. She still helps run Beyond the Chair, but her days are mostly spent being a mom and promoting adult stem cell research.

Says Laura, a lot of people ask me about my experience with stem cells. I always tell them that at the end of the day the decision is up to them. But I promote them, I believe in them, I experienced it.

I think having the adult stem cell procedure was the best decision that Ive ever made.(Quote) I think that its been very beneficial, its helped me out so much, Laura said. My hope is that I can help other people and encourage other people. And spread the word about adult stem cells.

Disclaimer: StemCellResearchFacts.org is committed to educate about adult stem cell clinical trials and treatments which are validated by published research and approved by the U.S. FDA or similar international agencies. Clinical trials may not be effective for all patients or conditions. We are not a research or clinical facility and do not provide clinical trials or treatments.

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Stem cells for stenosis – Dr. Marc Darrow is a Stem Cell …

By Sykes24Tracey

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions aboutthis articleusing the contact form below.

I want to begin this article with a case study from our recently published research in theBiomedical Journal of Scientific & Technical Research.

Afterphysical assessment of her lower back, we determinedher pain was generated from a lumbosacral sprain. Not the narrowing of the L1-L5,S1

She had oneBone marrow derived stem cell treatment and at first follow up two weeks after the injections,the patient experienced no pain or stiffness and reported 90% total improvement. Approximately a year after treatment, she felt evenbetter, and stated that she was able to perform aerobics and line dancing for an hour and a half a day with no pain. She reportedinfrequent stiffness, but not as severe as it was prior to treatment.

Her resting and active pain were 0/10 and functionality score was 39/40.(1)

This was one document case in the medical literature. Over the years we have helped many people avoid a stenosis surgery they did not want or possibly did not even need.

Despite the fact that many studies insist that surgical treatment is the best option for lumbar spinal stenosis, a startling study was published in the medical journal Spine. In this study, American, Canadian and Italian researchers published their evidence:

We have very little confidence to conclude whether surgicaltreatmentor a conservative approach is better forlumbarspinal stenosis, and we can provide no new recommendations to guide clinical practice. . .However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservativetreatment. (2)

In the above research it should be pointed out the comparison between lumbar surgery and conservative treatments did not include stem cell therapy. They included the traditional conservative treatments including physical therapy, cortisone injections, pain medications and others listed below.

One of the reasons surgery may be no better than conservative care is that the surgery tried to fix a problem that was not there: Pain.

In the medical journal Osteoarthritis and Cartilage,doctors reported that many asymptomatic individuals, those with no pain or other challenges, have radiographic lumbar spinal stenosis. In other words they only have lumbar spinal stenosis on the MRI.

The doctors noted:

A diagnosis of spinal stenosis can be frightening because of the implications that a surgery may be needed to avoid paralysis.It is important to note that in instances where stenosis is so severe that the patient has lost circulation to the legs or bladder control a surgical consult should be made immediately.

In the December 2017 edition of the medical journal Spine, doctors from the University of Pittsburgh and University Toronto reported these observations in patients seeking non-surgical treatments for lumbar spinal stenosis.

Individuals with lumbar spinal stenosis may believe misinformation and information from non-medical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with lumbar spinal stenosis.(4)

Back pain can certainly cause anxiety, depression, and catastrophizing thoughts. The people in this study wanted education and involvement in their choice of treatment. I hope I can provide some for you here in this article.

Lumbar Spinal Stenosis is a narrowing of the space between vertebrae where the spinal cord and the spinal nerves travel. It is a diagnostic term to describe lower back pain with or without weakness and loss of sensation in the legs. It is a very common condition brought on mostly by aging and the accompanying degeneration of the spine.

In the recommended surgical procedures for spinal stenosis, two choices are the most favored.

A paper published in October 2017 gives a good outline where conservative medicine is in the treatment of Lumbar stenosis. It is from doctors at the University of South Carolina

This is indeed a fair assessment of SOME of the treatment options available to patients.However, not all doctors agree. At New York University in June 2017 research, doctors wrote:

The highest levels of evidence do not support minimally invasive surgery over open surgery for cervical orlumbardisc herniation. However, minimally invasive surgery fusion demonstrates advantages along with higher revision and hospital readmission rates. These results should optimize informed decision-making regarding minimally invasive surgery versus open spine surgery, particularly in the current advertising climate greatly favoring minimally invasive surgery.(6)

Researchers at theUniversity of Sydneysay that the evidence for recommending lumbar spinal surgery as the best option to patients is lacking and it is possible that a sham or placebo surgery can deliver the same results.(7)

In the research I cited at the top of this article, doctors at the Italian Scientific Spine Institute in Milanwrote: We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with lumbar spinal stenosis. We can however report on the high rate of effects reported in three of five surgical groups and that no side effects were reported for any of the conservative treatment options.(8)

Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients

Ateam of Japanese researchers found thatpatients with lumbar spinal stenosiswho do not improve after nonsurgical treatments are typically treated surgically using decompressive surgeryand spinal fusion surgery. Unfortunately the researchers could not determine if the surgery had any benefit either.(9)Maybe the patients problem was not the stenosis?

Now lets go to another paper that has more of an opinion: From Dr. Nancy Epstein ofWinthrop University Hospital:

Surgeons at Leiden University Medical Centre in the Netherlandsspeculate that doctors go into a diagnosis oflumbar spinal stenosis with the thought that there is osteoarthritis a bony overgrowth on the spinal nerves. Once determined, the symptoms of patients can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication nerve inflammation).

In the patients who primarily complain of radiculopathy (radiating leg pain) with an stable spine, a decompression surgery may be recommendedto removebonefrom around thenerve root to give the nerve root more space.The surgeons warn of thefear that surgery to a stable spine will make it unstable.(11)

Afusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves is another option. As mentioned by independent research above surgery for spinal stenosis should onlybe considered after conservative therapies have been exhausted.Surgical treatment of lumbar spinal disorders, including fusion, is associated with a substantial risk of intraoperative and perioperative complications,as pointed out in the research by surgeons from Catholic University in Rome.(12)

Bone growth occurs in the spine because the bone is trying to stabilize the spine from excessive movement or laxity. Fusion surgery is recommended as a means to accelerate that type of stabilization. Regenerative medicine includingPRP andStem Cell Therapy(watch the video)works in a completely different way. Theystabilize the spine by strengthening the often forgotten and underappreciated spinal ligaments and tendons.These techniques help stabilize the spine, which is imperative as unstable joints can lead to or further exacerbate the arthritis that causes spinal stenosis.

In the medical journal Insights into imaging, researchers wrote of the four factors associated with the degenerative changes of the spine that cause spinal canal stenosis:

The same research suggests that these conditions can prevent the formation of new tissue (collagen) which can initiate repair.(13)

Collagen is of course the elastic material of skin and ligaments. Here the association between collagen interruption and spinal stenosis can be made to show spinal instability can be THE problem of symptomatic stenosis.

A fascinating study on what damaged spinal ligaments can do

A fascinating study in the Asian Spine Journal investigated the relationship between ligamentum flavum thickening and lumbar segmental instability, disc degeneration, and facet joint osteoarthritis. Ligament thickening is the result of chronic inflammation. Chronic ligament inflammation is the result of a ligament injury that is not healing.

What these researchers found was a significant correlation between ligamentum flavum thickness, spinal instability and disc degeneration. More so, the worse the degenerative disc disease, the worse the ligamentum flavum thickness.(14)

PRP and stem cells address the problem of ligament damage and inflammation. Addressing these problems address the problems of spinal instability. Addressing the problems of spinal instability can address the problems of spinal and cervical stenosis.

A leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300

1 Darrow M, Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461.

2 Zaina F, TomkinsLane C, Carragee E, Negrini S. Surgical versus nonsurgical treatment for lumbar spinal stenosis. The Cochrane Library. 2016 Jul 1.

3 Lynch AD, Bove AM, Ammendolia C, Schneider M. Individuals with lumbar spinal stenosis seek education and care focused on self-managementresults of focus groups among participants enrolled in a randomized controlled trial. The Spine Journal. 2017 Dec 12

4 Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis and cartilage. 2013 Jun 1;21(6):783-8.

5Patel J, Osburn I, Wanaselja A, Nobles R. Optimal treatment for lumbar spinal stenosis: an update. Current Opinion in Anesthesiology. 2017 Oct 1;30(5):598-603.

6 Vazan M, Gempt J, Meyer B, Buchmann N, Ryang YM. Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature. Acta Neurochir (Wien). 2017 Jun;159(6):1137-1146

7Machado GC, Ferreira PH, Yoo RI, et al. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Nov 1;11:CD012421.

8Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical Versus Nonsurgical Treatment for Lumbar Spinal Stenosis. Spine (Phila Pa 1976). 2016 Jul 15;41(14):E857-68.

9 Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol. 2016 Oct;26(7):695-704. doi: 10.1007/s00590-016-1818-3. Epub 2016 Jul 25.

10 Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery: Lets tell someone. Surg Neurol Int. 2016 Jan 25;7(Suppl 3):S96-S101. doi: 10.4103/2152-7806.174896. eCollection 2016.

11Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC.Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014 Aug 7. [Epub ahead of print]

12.Proietti L, Scaramuzzo L, Schiro GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013 Jul;47(4):340-5. doi: 10.4103/0019-5413.114909.

13 Kushchayev SV, Glushko T, Jarraya M, et al. ABCs of the degenerative spine.Insights into Imaging. 2018;9(2):253-274. doi:10.1007/s13244-017-0584-z.

14 Yoshiiwa T, Miyazaki M, Notani N, Ishihara T, Kawano M, Tsumura H. Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis.Asian Spine Journal. 2016;10(6):1132-1140. doi:10.4184/asj.2016.10.6.1132.2373

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Scientists regenerate spinal cord in injured rats with …

By raymumme

With patches of stem cells on their broken spinal cords, partially paralyzed rats once againreached out and grabbed distant treats, researchers report in Nature Medicine.

While previous studies have shown progress in regenerating certain types of nerve cells in injured spinal cords, the study is the first to coax the regrowth of a specific set of nerve cells, called corticospinal axons. These bundles of biological wiring carry signals from the brain to the spinal cord and are critical for voluntary movement. In the study, researchers were able to use stem cells from rats and humans to mend the injured rodents.

The corticospinal projection is the most important motor system in humans, senior author Mark Tuszynski at the University of California, San Diego said. It has not been successfully regenerated before. Many have tried, many have failedincluding us, in previous efforts.

For the study, the researchers used rat and human neural progenitor cells, which can produce several different types of cells found in the central nervous system. The researchers coaxed the cells into forming spinal cord tissue using specific chemical signals. When injected into the damaged spinal cords of rats, the cells took root, filling lesions with new tissue and corticospinal axons. And the new nerve cells linked up with the severed connections left hanging from the injury, allowing signals to traverse the patch.

In mobility tests, injured rats that got the spinal patch could better stretch out their front legs to grab hard-to-reach treats compared with injured rats without the stem-cell grafts.

Still, the cord-patching method is far from clinical use in humans, the authors caution. Researchers will need to follow the rats to look at long-term safety and effectiveness of the patches. Then, they'll have to try out the patches in other animal models before optimizing the method for humans.

But,Tuszynski said, "now that we can regenerate the most important motor system for humans, I think that the potential for translation is more promising."

Nature Medicine, 2015. DOI: 10.1038/nm.4066 (About DOIs).

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Spinal Cord Injury Types of Injury, Diagnosis and Treatment

By LizaAVILA

According to the National Spinal Cord Injury Association, as many as 450,000 people in the U.S. are living with a spinal cord injury (SCI). Other organizations conservatively estimate this figure to be about 250,000.

The spinal cord is about 18 inches long, extending from the base of the brain to near the waist. Many of the bundles of nerve fibers that make up the spinal cord itself contain upper motor neurons (UMNs). Spinal nerves that branch off the spinal cord at regular intervals in the neck and back contain lower motor neurons (LMNs).

Types and Levels of SCI

The severity of an injury depends on the part of the spinal cord that is affected. The higher the SCI on the vertebral column, or the closer it is to the brain, the more effect it has on how the body moves and what one can feel. More movement, feeling and voluntary control are generally present with injuries at lower levels.

Tetraplegia (a.k.a. quadriplegia) results from injuries to the spinal cord in the cervical (neck) region, with associated loss of muscle strength in all four extremities.

Paraplegia results from injuries to the spinal cord in the thoracic or lumbar areas, resulting in paralysis of the legs and lower part of the body.

Complete SCI

A complete SCI produces total loss of all motor and sensory function below the level of injury. Nearly 50 percent of all SCIs are complete. Both sides of the body are equally affected. Even with a complete SCI, the spinal cord is rarely cut or transected. More commonly, loss of function is caused by a contusion or bruise to the spinal cord or by compromise of blood flow to the injured part of the spinal cord.

Incomplete SCI

In an incomplete SCI, some function remains below the primary level of the injury. A person with an incomplete injury may be able to move one arm or leg more than the other or may have more functioning on one side of the body than the other. An incomplete SCI often falls into one of several patterns.

Anterior cord syndrome results from injury to the motor and sensory pathways in the anterior parts of the spinal cord. These patients can feel some types of crude sensation via the intact pathways in the posterior part of the spinal cord, but movement and more detailed sensation are lost.

Central cord syndrome usually results from trauma and is associated with damage to the large nerve fibers that carry information directly from the cerebral cortex to the spinal cord. Symptoms may include paralysis and/or loss of fine control of movements in the arms and hands, with far less impairment of leg movements. Sensory loss below the site of the SCI and loss of bladder control may also occur, with the overall amount and type of functional loss related to the severity of damage to the nerves of the spinal cord.

Brown-Sequard syndrome is a rare spinal disorder that results from an injury to one side of the spinal cord. It is usually caused by an injury to the spine in the region of the neck or back. In many cases, some type of puncture wound in the neck or in the back that damages the spine may be the cause. Movement and some types of sensation are lost below the level of injury on the injured side. Pain and temperature sensation are lost on the side of the body opposite the injury because these pathways cross to the opposite side shortly after they enter the spinal cord.

Injuries to a specific nerve root may occur either by themselves or together with a SCI. Because each nerve root supplies motor and sensory function to a different part of the body, the symptoms produced by this injury depend upon the pattern of distribution of the specific nerve root involved.

"Spinal concussions" can also occur. These can be complete or incomplete, but spinal cord dysfunction is transient, generally resolving within one or two days. Football players are especially susceptible to spinal concussions and spinal cord contusions. The latter may produce neurological symptoms including numbness, tingling, electric shock-like sensations and burning in the extremities. Fracture-dislocations with ligamentous tears may be present in this syndrome.

Penetrating SCI

"Open" or penetrating injuries to the spine and spinal cord, especially those caused by firearms, may present somewhat different challenges. Most gunshot wounds to the spine are stable; i.e., they do not carry as much risk of excessive and potentially dangerous motion of the injured parts of the spine. Depending upon the anatomy of the injury, the patient may need to be immobilized with a collar or brace for several weeks or months so that the parts of the spine that were fractured by the bullet may heal. In most cases, surgery to remove the bullet does not yield much benefit and may create additional risks, including infection, cerebrospinal fluid leak and bleeding. However, occasional cases of gunshot wounds to the spine may require surgical decompression and/or fusion in an attempt to optimize patient outcome.

Diagnosis

When SCI is suspected, immediate medical attention is required. SCI is usually first diagnosed when the patient presents with loss of function below the level of injury.

Signs and Symptoms of Possible SCI:

Clinical Evaluation

A physician may decide that significant SCI does not exist simply by examining a patient who does not have any of the above symptoms, as long as the patient meets the following criteria: unaltered mental status, no neurological deficits, no intoxication from alcohol, drugs or medications and no other painful injuries that may divert his or her attention away from a SCI.

In other cases, such as when patients complain of neck pain, when they are not fully awake, or when they have obvious weakness or other signs of neurological injury, the cervical spine is kept in a rigid collar until appropriate radiological studies are completed.

Radiological Evaluation

The radiological diagnosis of SCI has traditionally begun with X-rays. In many cases, the entire spine may be X-rayed. Patients with a SCI may also receive both computerized tomography (CT or CAT scan) and magnetic resonance imaging (MRI) of the spine. In some patients, centers may proceed directly to CT scanning as the initial radiological test. For patients with known or suspected injuries, MRI is helpful for looking at the actual spinal cord itself, as well as for detecting any blood clots, herniated discs or other masses that may be compressing the spinal cord. CT scans may be helpful in visualizing the bony anatomy, including any fractures.

Even after all radiological tests have been performed, it may be advisable for a patient to wear a collar for a variable period of time. If patients are awake and alert, but still complaining of neck pain, a physician may send them home in a collar, with plans to repeat X-rays in the near future, such as in one to two weeks. The concern in these cases is that muscle spasm caused by pain might be masking an abnormal alignment of the bones in the spinal column. Once this period of spasm passes, repeat X-rays may reveal abnormal alignment or excessive motion that was not visible immediately after the injury. In patients who are comatose, confused or not fully cooperative for some other reason, adequate radiographic visualization of parts of the spine may be difficult. This is especially true of the bones at the very top of the cervical spine. In such cases, the physician may keep the patient in a collar until the patient is more cooperative. Alternatively, the physician may obtain other imaging studies to look for a radiologically-evident injury.

Treatment

Treatment of SCI begins before the patient is admitted to the hospital. Paramedics or other emergency medical services personnel carefully immobilize the entire spine at the scene of the accident. In the emergency department, this immobilization is continued while more immediate life-threatening problems are identified and addressed. If the patient must undergo emergency surgery because of trauma to the abdomen, chest or another area, immobilization and alignment of the spine are maintained during the operation.

Intensive Care Unit Treatment

If a patient has a SCI, he or she will usually be admitted to an intensive care unit (ICU). For many injuries of the cervical spine, traction may be indicated to help bring the spine into proper alignment. Standard ICU care, including maintaining a stable blood pressure, monitoring cardiovascular function, ensuring adequate ventilation and lung function and preventing and promptly treating infection and other complications, is essential so that SCI patients can achieve the best possible outcome.

Surgery

Occasionally, a surgeon may wish to take a patient to the operating room immediately if the spinal cord appears to be compressed by a herniated disc, blood clot or other lesion. This is most commonly done for patients with an incomplete SCI or with progressive neurological deterioration.

Even if surgery cannot reverse damage to the spinal cord, surgery may be needed to stabilize the spine to prevent future pain or deformity. The surgeon will decide which procedure will provide the greatest benefit to the patient.

Outcome

Persons with neurologically complete tetraplegia are at high risk for secondary medical complications. The percentages of complications for individuals with neurologically complete tetraplegia have been reported as follows:

Pressure ulcers are the most frequently observed complications, beginning at 15 percent during the first year post-injury and steadily increasing thereafter. The most common pressure ulcer location is the sacrum, the site of one third of all reported ulcers.

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, Annual Statistical Report, June 2004

Neurological Improvement

Recovery of function depends upon the severity of the initial injury. Unfortunately, those who sustain a complete SCI are unlikely to regain function below the level of injury. However, if there is some degree of improvement, it usually evidences itself within the first few days after the accident.

Incomplete injuries usually show some degree of improvement over time, but this varies with the type of injury. Although full recovery may be unlikely in most cases, some patients may be able to improve at least enough to ambulate and to control bowel and bladder function. Patients with anterior cord syndrome tend to do poorly, but many of those with Brown-Sequard syndrome can expect to reach these goals. Patients with central cord syndrome often recover to the point of being ambulatory and controlling bowel and bladder function, but they often are not able to perform detailed or intricate work with their hands.

Once a patient is stabilized, care and treatment focuses on supportive care and rehabilitation. Family members, nurses or specially trained aides all may provide supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores and other assistance.

Rehabilitation often includes physical therapy, occupational therapy and counseling for emotional support. The services may initially be provided while the patient is hospitalized. Following hospitalization, some patients are admitted to a rehabilitation facility. Other patients can continue rehab on an outpatient basis and/or at home.

Mortality

Mortality associated with SCI is influenced by several factors. Perhaps the most important of these is the severity of associated injuries. Because of the force that is required to fracture the spine, it is not uncommon for a SCI patient to suffer significant damage to the chest and/or abdomen. Many of these associated injuries can be fatal. In general, younger patients and those with incomplete injuries have a better prognosis than older patients and those with complete injuries.

Respiratory diseases are the leading cause of death in people with SCI, pneumonia accounting for 71.2 percent of these deaths. The second and third leading causes of death, respectively, are heart disease and infections.

The cumulative 20-year survival rate for SCI patients is 70.65 percent, but due to underreporting and cases that are lost in follow-up, the mortality rates may be higher.

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, Annual Statistical Report, June 2004

SCI Prevention

While recent advances in emergency care and rehabilitation allow many SCI patients to survive, methods for reducing the extent of injury and for restoring function are still limited. Currently, there is no cure for SCI. However, ongoing research to test surgical and drug therapies continues to make progress. Drug treatments,decompression surgery,nerve cell transplantation,nerve regeneration, stem cells and complex drug therapies are all being examined in clinical trials as ways to overcome the effects of SCI. However, SCI prevention is crucial to decreasing the impact of these injuries on individual patients and on society.

Motor Vehicle Safety Tips:

Tips to Prevent Falls in the Home:

Water and Sports Safety Tips:

Firearms Safety:

SCI Resources

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS Find a Board-certified Neurosurgeon online tool.

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Repairing the Damaged Spinal Cord – Scientific American

By Dr. Matthew Watson

Editor's Note: This story, originally printed in the September 1999 issue of Scientific American, is being posted due to a new study showing that nerve cells can be regenerated by knocking out genes that typically inhibit their growth.

For Chinese gymnast Sang Lan, the cause was a highly publicized headfirst fall during warm-ups for the 1998 Goodwill Games. For Richard Castaldo of Littleton, Colo., it was bullets; for onetime football player Dennis Byrd, a 1992 collision on the field; and for a child named Samantha Jennifer Reed, a fall during infancy. Whatever the cause, the outcome of severe damage to the spinal cord is too often the same: full or partial paralysis and loss of sensation below the level of the injury.

Ten years ago doctors had no way of limiting such disability, aside from stabilizing the cord to prevent added destruction, treating infections and prescribing rehabilitative therapy to maximize any remaining capabilities. Nor could they rely on the cord to heal itself. Unlike tissue in the peripheral nervous system, that in the central nervous system (the spinal cord and brain) does not repair itself effectively. Few scientists held out hope that the situation would ever change.

Then, in 1990, a human trial involving multiple research centers revealed that a steroid called methylprednisolone could preserve some motor and sensory function if it was administered at high doses within eight hours after injury. For the first time, a therapy had been proved to reduce dysfunction caused by spinal cord trauma. The improvements were modest, but the success galvanized a search for additional therapies. Since then, many investigatorsincluding us have sought new ideas for treatment in studies of why an initial injury triggers further damage to the spinal cord and why the disrupted tissue fails to reconstruct itself.

In this article we will explain how the rapidly burgeoning knowledge might be harnessed to help people with spinal cord injuries. We should note, however, that workers have also been devising strategies that compensate for cord damage instead of repairing it. In the past two years, for example, the U.S. Food and Drug Administration has approved two electronic systems that regulate muscles by sending electrical signals through implanted wires. One returns certain hand movements (such as grasping a cup or a pen) to patients who have shoulder mobility; another restores a measure of control over the bladder and bowel.

A different approach can also provide grasping ability to certain patients. Surgeons identify tendons that link paralyzed forearm muscles to the bones of the hand, disconnect them from those muscles and connect them to arm muscles regulated by parts of the spine above the injury (and thus still under voluntary control). Further, many clinicians suspect that initiating rehabilitative therapy earlyexercising the limbs almost as soon as the spine is stabilizedmay enhance motor and sensory function in limbs. Those perceptions have not been tested rigorously in people, but animal studies lend credence to them.

The Cord at Work The organ receiving all this attention is no thicker than an inch but is the critical highway of communication between the brain and the rest of the body. The units of communication are the nerve cells (neurons), which consist of a bulbous cell body (home to the nucleus), trees of signal-detecting dendrites, and an axon that extends from the cell body and carries signals to other cells. Axons branch toward their ends and can maintain connections, or synapses, with many cells at once. Some traverse the entire length of the cord.

The soft, jellylike cord has two major systems of neurons. Of these, the descending, motor pathways control both smooth muscles of internal organs and striated muscles; they also help to modulate the actions of the autonomic nervous system, which regulates blood pressure, temperature and the bodys circulatory response to stress. The descending pathways begin with neurons in the brain, which send electrical signals to specific levels, or segments, of the cord. Neurons in those segments then convey the impulses outward beyond the cord.

The other main system of neurons the ascending, sensory pathwaystransmit sensory signals received from the extremities and organs to specific segments of the cord and then up to the brain. Those signals originate with specialized, transducer cells, such as sensors in the skin that detect changes in the environment or cells that monitor the state of internal organs. The cord also contains neuronal circuits (such as those involved in reflexes and certain aspects of walking) that can be activated by incoming sensory signals without input from the brain, although they can be influenced by messages from the brain.

The cell bodies in the trunk of the cord reside in a gray, butterfly-shaped core that spans the length of the spinal cord. The ascending and descending axonal fibers travel in a surrounding area known as the white matter, so called because the axons are wrapped in myelin, a white insulating material. Both regions also house glial cells, which help neurons to survive and work properly. The glia include star-shaped astrocytes, microglia (small cells that resemble components of the immune system) and oligodendrocytes, the myelin producers. Each oligodendrocyte myelinates as many as 40 different axons simultaneously.

The precise nature of a spinal cord injury can vary from person to person. Nevertheless, certain commonalities can be discerned.

When Injury Strikes When a fall or some other force fractures or dislocates the spinal column, the vertebral bones that normally enclose and protect the cord can crush it, mechanically killing and damaging axons. Occasionally, only the gray matter in the damaged area is significantly disrupted. If the injury ended there, muscular and sensory disturbances would be confined to tissues that send input to or receive it from neurons in the affected level of the cord, without much disturbing function below that level.

For instance, if only the gray matter were affected, a cervical 8 (C8) lesion involving the cord segment where the nerves labeled C8 originatewould paralyze the hands without impeding walking or control over the bowel and bladder. No signals would go out to, or be received from, the tissues connected to the C8 nerves, but the axons conveying signals up and down the surrounding white matter would keep working.

In contrast, if all the white matter in the same cord segment were destroyed, the injury would now interrupt the vertical signals, stopping messages that originated in the brain from traveling below the damaged area and blocking the flow to the brain of sensory signals coming from below the wound. The person would become paralyzed in the hands and lower limbs and would lose control over urination and defecation.

Sadly, the initial insult is only the beginning of the trouble. The early mechanical injury triggers a second wave of damageone that, over the subsequent minutes, hours and days, progressively enlarges the lesion and thus the extent of functional impairment. This secondary spread tends to occur longitudinally through the gray matter at first before expanding into the white matter (roughly resembling the inflation of a footballshaped balloon). Eventually the destruction can encompass several spinal segments above and below the original wound.

The end result is a complex state of disrepair. Axons that have been damaged become useless stumps, connected to nothing, and their severed terminals disintegrate. Often many axons remain intact but are rendered useless by loss of their insulating myelin. A fluid-filled cavity, or cyst, sits where neurons, other cells and axons used to be. And glial cells proliferate abnormally, creating clusters termed glial scars. Together the cyst and scars pose a formidable barrier to any cut axons that might somehow try to regrow and connect to cells they once innervated. A few axons may remain whole, myelinated and able to carry signals up or down the spine, but often their numbers are too small to convey useful directives to the brain or muscles.

First, Contain the Damage If all these changes had to be fully reversed to help patients, the prospects for new treatments would be grim. Fortunately, it appears that salvaging normal activity in as little as 10 percent of the standard axon complement would sometimes make walking possible for people who would otherwise lack that capacity. In addition, lowering the level of injury by just a single segment (about half an inch) can make an important difference to a persons quality of life. People with a C6 injury have no power over their arms, save some ability to move their shoulders and flex their elbows. But individuals with a lower, C7 injury can move the shoulders and elbow joints and extend the wrists; with training and sometimes a tendon transfer, they can make some use of their arms and hands.

Because so much damage arises after the initial injury, clarifying how that secondary destruction occurs and blocking those processes are critical. The added wreckage has been found to result from many interacting mechanisms.

Within minutes of the trauma, small hemorrhages from broken blood vessels appear, and the spinal cord swells. The blood vessel damage and swelling prevent the normal delivery of nutrients and oxygen to cells, causing many of them to starve to death.

Meanwhile damaged cells, axons and blood vessels release toxic chemicals that go to work on intact neighboring cells. One of these chemicals in particular triggers a highly disruptive process known as excitotoxicity. In the healthy cord the end tips of many axons secrete minute amounts of glutamate. When this chemical binds to receptors on target neurons, it stimulates those cells to fire impulses. But when spinal neurons, axons or astrocytes are injured, they release a flood of glutamate. The high levels overexcite neighboring neurons, inducing them to admit waves of ions that then trigger a series of destructive events in the cellsincluding production of free radicals. These highly reactive molecules can attack membranes and other components of formerly healthy neurons and kill them.

Until about a year ago, such excitotoxicity, also seen after a stroke, was thought to be lethal to neurons alone, but new results suggest it kills oligodendrocytes (the myelin producers) as well. This effect may help explain why even unsevered axons become demyelinated, and thus unable to conduct impulses, after spinal cord trauma.

Prolonged inflammation, marked by an influx of certain immune system cells, can exacerbate these effects and last for days. Normally, immune cells stay in the blood, unable to enter tissues of the central nervous system. But they can flow in readily where blood vessels are damaged. As they and microglia become activated in response to an injury, the activated cells release still more free radicals and other toxic substances.

Methylprednisolone, the first drug found to limit spinal cord damage in humans, may act in part by reducing swelling, inflammation, the release of glutamate and the accumulation of free radicals. The precise details of how it helps patients remain unclear, however.

Studies of laboratory animals with damaged spinal cords indicate that drugs able to stop cells from responding to excess glutamate could minimize destruction as well. Agents that selectively block glutamate receptors of the so-called AMPA class, a kind abundant on oligodendrocytes and neurons, seem to be particularly effective at limiting the final extent of a lesion and the related disability. Certain AMPA receptor antagonists have already been tested in early human trials as a therapy for stroke, and related compounds could enter safety studies in patients with spinal cord injury within several years.

Much of the early cell loss in the injured spinal cord occurs by necrosis, a process in which cells essentially become passive victims of murder. In the past few years, neurobiologists have also documented a more active form of cell death, somewhat akin to suicide, in the cord. Days or weeks after the initial trauma, a wave of this cell suicide, or apoptosis, frequently sweeps through oligodendrocytes as many as four segments from the trauma site. This discovery, too, has opened new doors for protective therapy. Rats given apoptosisinhibiting drugs retained more ambulatory ability after a traumatic spinal cord injury than did untreated rats.

In the past few years, biologists have identified many substances, called neurotrophic factors, that also promote neuronal and glial cell survival. A related substance, GM-1 ganglioside (Sygen), is now being evaluated for limiting cord injury in humans. Ultimately, interventions for reducing secondary damage in the spinal cord will probably enlist a variety of drugs given at different times to thwart specific mechanisms of death in distinct cell populations.

The best therapy would not only reduce the extent of an injury but also repair damage. A key component of that repair would be stimulating the regeneration of damaged axonsthat is, inducing their elongation and reconnection with appropriate target cells.

Although neurons in the central nervous system of adult mammals generally fail to regenerate damaged axons, this lapse does not stem from an intrinsic property of those cells. Rather the fault lies with shortcomings in their environment. After all, neurons elsewhere in the body and in the immature spinal cord and brain regrow axons readily, and animal experiments have shown that the right environment can induce axons of the spinal cord to extend quite far.

Then, Induce Regeneration One shortcoming of the cord environment turns out to be an overabundance of molecules that actively inhibit axonal regenerationsome of them in myelin. The scientists who discovered these myelin-related inhibitors have produced a molecule named IN-1 (inhibitorneutralizing antibody) that blocks the action of those inhibitors. They have also demonstrated that infusion of mouse-derived IN-1 into the injured rat spinal cord can lead to long-distance regrowth of some interrupted axons. And when pathways controlling front paw activity are severed, treated animals regain some paw motion, whereas untreated animals do not. The rodent antibody would be destroyed by the human immune system, but workers are developing a humanized version for testing in people.

Many other inhibitory molecules have now been found as well, including some produced by astrocytes and a number that reside in the extracellular matrix (the scaffolding between cells). Given this array, it seems likely that combination therapies will be needed to counteract or shut down the production of multiple inhibitors at once.

Beyond removing the brakes on axonal regrowth, a powerful tactic would supply substances that actively promote axonal extension. The search for such factors began with studies of nervous system development. Decades ago scientists isolated nerve growth factor (NGF), a neurotrophic factor that supports the survival and development of the peripheral nervous system. Subsequently, this factor turned out to be part of a family of proteins that both enhance neuronal survival and favor the outgrowth of axons. Many other families of neurotrophic factors with similar talents have been identified as well. For instance, the molecule neurotrophin- 3 (NT-3) selectively encourages the growth of axons that descend into the spinal cord from the brain.

Luckily, adult neurons remain able to respond to axon-regenerating signals from such factors. Obviously, however, natural production of these substances falls far short of the amount needed for spinal cord repair. Indeed, manufacture of some of the compounds apparently declines, instead of rising, for weeks after a spinal trauma occurs. According to a host of animal studies, artificially raising those levels after an injury can enhance regeneration. Some regeneration- promoting neurotrophic factors, such as basic fibroblast growth factor, have been tested in stroke patients. None has been evaluated as an aid to regeneration in people with spinal cord damage, but many are being assessed in animals as a prelude to such studies.

Those considering neurotrophic factors for therapy will have to be sure that the agents do not increase pain, a common long-term complication of spinal cord injury. This pain has many causes, but one is the sprouting of nascent axons where they do not belong (perhaps in a failed attempt to address the injury) and their inappropriate connection to other cells. The brain sometimes misinterprets impulses traveling through those axons as pain signals. Neurotrophic factors can theoretically exacerbate that problem and can also cause pain circuits in the spiral cord and pain-sensing cells in the skin to become oversensitive.

After axons start growing, they will have to be guided to their proper targets, the cells to which they were originally wired. But how? In this case, too, studies of embryonic development have offered clues.

During development, growing axons are led to their eventual targets by molecules that act on the leading tip, or growth cone. In the past five years especially, a startling number of substances that participate in this process have been uncovered. Some, such as a group called netrins, are released or displayed by neurons or glial cells. They beckon axons to grow in some directions and repel growth in others. Additional guidance molecules are fixed components of the extracellular matrix. Certain of the matrix molecules bind well to specific molecules (cell adhesion molecules) on the growth cones and thus provide anchors for growing axons. During development, the required directional molecules are presented to the growth cones in specific sequences.

Establish Proper Connections At the moment, no one knows how to supply all the needed chemical road signs in the right places. But some findings suggest that regeneration may be aided by supplying just a subset of those targeting moleculessay, a selection of netrins and components from the extracellular matrix. Substances already in the spinal cord may well be capable of supplying the rest of the needed guidance.

A different targeting approach aims to bridge the gap created by cord damage. It directs injured axons toward their proper destinations by supplying a conduit through which they can travel or by providing another friendly scaffolding able to give physical support to the fibers as they try to traverse the normally impenetrable cyst. The scaffolding can also serve as a source of growth-promoting chemicals.

For instance, researchers have implanted tubes packed with Schwann cells into the gap where part of the spinal cord was removed in rodents. Schwann cells, which are glia of the peripheral nervous system, were chosen because they have many attributes that favor axonal regeneration. In animal experiments, such grafts spurred some axonal growth into the tubes.

A second bridging material consists of olfactory-ensheathing glial cells, which are found only in the tracts leading from the nose to the olfactory bulbs of the brain. When those cells were put into the rat spinal cord where descending tracts had been cut, the implants spurred partial regrowth of the axons over the implant. Transplanting the olfactory-ensheathing glia with Schwann cells led to still more extensive growth.

In theory, a biopsy could be performed to obtain the needed olfactory ensheathing glia from a patient. But once the properties that enable them (or other cells) to be competent escorts for growing axons are determined, researchers may instead be able to genetically alter other cell types if desired, giving them the required combinations of growthpromoting properties.

Fibroblasts (cells common in connective tissue and the skin) are among those already being engineered to serve as bridges. They have been altered to produce the neurotrophic molecule NT-3 and then transplanted into the cut spinal cord of rodents. The altered fibroblasts have resulted in partial regrowth of axons. Along with encouraging axonal regrowth, NT-3 stimulates remyelination. In these studies the genetically altered fibroblasts have enhanced myelination of regenerated axons and improved hind limb activity.

Replace Lost Cells Other transplantation schemes would implant cells that normally occur in the central nervous system. In addition to serving as bridges and potentially releasing proteins helpful for axonal regeneration, certain of these grafts might be able to replace cells that have died.

Transplantation of tissue from the fetal central nervous system has produced a number of exciting results in animals treated soon after a trauma. This immature tissue can give rise to new neurons, complete with axons that travel long distances into the recipients tissues (up and down several segments in the spinal cord or out to the periphery). It can also prompt host neurons to send regenerating axons into the implanted tissue. In addition, transplant recipients, unlike untreated animals, may recover some limb function, such as the ability to move the paw in useful ways. What is more, studies of fetal tissue implants suggest that axons can at times find appropriate targets even in the absence of externally supplied guidance molecules. The transplants, however, are far more effective in the immature spinal cord than in the injured adult cordan indication that young children would probably respond to such therapy much better than adolescents or adults would.

Some patients with long-term spinal cord injuries have received human fetal tissue transplants, but too little information is available so far for drawing any conclusions. In any case, application of fetal tissue technology in humans will almost surely be limited by ethical dilemmas and a lack of donor tissue. Therefore, other ways of achieving the same results will have to be devised. Among the alternatives is transplanting stem cells: immature cells that are capable of dividing endlessly, of making exact replicas of themselves and also of spawning a range of more specialized cell types.

Various kinds of stem cells have been identified, including ones that generate all the cell types in the blood system, the skin, or the spinal cord and brain. Stem cells found in the human adult central nervous system have, moreover, been shown capable of producing neurons and all their accompanying glia, although these so-called neural stem cells seem to be quiescent in most regions of the system. In 1998 a few laboratories also obtained much more versatile stem cells from human tissue. These human embryonic stem cells (in common with embryonic stem cells obtained previously from other vertebrates) can be grown in culture and, in theory, can yield almost all the cell types in the body, including those of the spinal cord.

Stem Cell Strategies How might stem cells aid in spinal cord repair? A great deal will be possible once biologists learn how to obtain those cells readily from a patient and how to control the cells differentiation. Notably, physicians might be able to withdraw neural stem cells from a patients brain or spinal cord, expand the numbers of the still undifferentiated cells in the laboratory and place the enlarged population in the same persons cord with no fear that the immune system will reject the implant as foreign. Or they might begin with frozen human embryonic stem cells, coax those cells to become precursors, or progenitors, of spinal cells and implant a large population of the precursors. Studies proposing to examine the effects on patients with spinal cord injuries of transplanting neural stem cells (isolated from the patients brains by biopsy) are being considered.

Simply implanting progenitor cells into the cord may be enough to prod them to multiply and differentiate into the needed lineages and thus to replace useful numbers of lost neurons and glial cells and establish the proper synaptic connections between neurons. Stem cells transplanted into the normal and injured nervous systems of animals can form neurons and glia appropriate for the region of transplantation. Combined with the fetal tissue results, this outcome signifies that many important cues for differentiation and targeting preexist in the injured nervous system. But if extra help is needed, scientists might be able to deliver it through genetic engineering. As a rule, to be genetically altered easily, cells have to be able to divide. Stem cells, unlike mature neurons, fit that bill.

Scenarios involving stem cell transplants are admittedly futuristic, but one day they themselves may become unnecessary, replaced by gene therapy alone. Delivery of genes into surviving cells in the spinal cord could enable those cells to manufacture and release a steady supply of proteins able to induce stem cell proliferation, to enhance cell differentiation and survival, and to promote axonal regeneration, guidance and remyelination. For now, though, technology for delivering genes to the central nervous system and for ensuring that the genes survive and work properly is still being refined.

Until, and even after, cell transplants and gene therapies become commonplace for coping with spinal cord injury, patients might gain help through a different avenuedrugs that restore signal conduction in axons quieted by demyelination. Ongoing clinical tests are evaluating the ability of a drug called 4-aminopyridine to compensate for demyelination. This agent temporarily blocks potassium ion channels in axonal membranes and, in so doing, allows axons to transmit electrical signals past zones of demyelination. Some patients receiving the drug have demonstrated modest improvement in sensory or motor function.

At first glance, this therapy might seem like a good way to treat multiple sclerosis, which destroys the myelin around axons of neurons in the central nervous system. Patients with this disease are prone to seizures, however, and 4-aminopyridine can exacerbate that tendency.

Neurotrophic factors, such as NT-3, that can stimulate remyelination of axons in animals could be considered for therapy as well. NT-3 is already entering extensive (phase III) trials in humans with spinal cord injury, though not to restore myelin. It will be administered by injection in amounts capable of acting on nerves in the gut and of enhancing bowel function, but the doses will be too low to yield high concentrations in the central nervous system. If the drug proves to be safe in this trial, though, that success could pave the way for human tests of doses large enough to enhance myelination or regeneration.

The Years Ahead Clearly, the 1990s have seen impressive advances in understanding of spinal cord injury and the controls on neuronal growth. Like axons inching toward their targets, a growing number of investigators are pushing their way through the envelope of discovery and generating a rational game plan for treating such damage. That approach will involve delivery of multiple therapies in an orderly sequence. Some treatments will combat secondary injury, some will encourage axonal regrowth or remyelination, and some will replace lost cells.

When will the new ideas become real treatments? We wish we had an answer. Drugs that work well in animals do not always prove useful in people, and those that show promise in small human trials do not always pan out when examined more extensively. It is nonetheless encouraging that at least two human trials are now under way and that others could start in the next several years.

Limiting an injury will be easier than reversing it, and so treatments for ameliorating the secondary damage that follows acute trauma can be expected to enter human testing most quickly. Of the repair strategies, promoting remyelination will be the simplest to accomplish, because all it demands is the recoating of intact axons. Remyelination strategies have the potential to produce meaningful recovery of function, such as returning control over the bladder or bowel abilities that uninjured people take for granted but that would mean the world to those with spinal cord injuries.

Of course, tendon-transfer surgery and advanced electrical devices can already restore important functions in some patients. Yet for many people, a return of independence in daily activities will depend on reconstruction of damaged tissue through the regrowth of injured axons and the reconnection of disrupted pathways.

So far, few interventions in animals with well-established spinal cord injuries have achieved the magnitude of regrowth and synapse formation that would be needed to provide a hand grasp or the ability to stand and walk in human adults with long-term damage. Because of the great complexities and difficulties involved in those aspects of cord repair, we cannot guess when reconstructive therapies might begin to become available. But we anticipate continued progress toward that end.

Traditionally, medical care for patients with spinal cord injury has emphasized compensatory strategies that maximize use of any residual cord function. That focus is now expanding, as treatments designed to repair the damaged cord and restore lost functionscience fiction only a decade agoare becoming increasingly plausible.

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Spinal Surgery Stem Cell Treatment | ProMedSPINE

By daniellenierenberg

Stem cells have the incredible ability to develop into a variety of different cell types within the body. In addition, stem cells can play a crucial role in internally repairing many types of tissues. During this process, stem cells divide, replenishing other cells without limit.

While stem cells have been used by medical professionals for a wide variety of reasons in order to treat injuries, ailments, and diseases affecting every part of the body, the use of stem cells in the treatment of spinal damage may be the most exciting and potent use yet. Through the application of these spinal treatments, patients have the ability to recover not only more completely, but also in a more natural and therefore more complete manner than ever before. When paired with the insight of a skilled spinal surgeon, the results can be astonishing.

If you or a loved one is suffering from spine damage and are looking to learn more about how stem cell treatments can help you, get in touch with the expert back team at ProMed SPINE today by filling out ouronline contact form. Schedule a consultation with us and begin the path to recovery today!

Stem cells differ from other cell types because they are unspecialized and therefore capable of renewing themselves through cell division. Under certain physiologic or experimental conditions, they have the ability to become tissue or even organ-specific cells with special functions. Given these unique regenerative abilities, stem cells offer new potential in the enhancement of every surgery.

Rather then undergoing an invasive surgery that wont actually repair damage from degenerative disc disease, stem cell spinal treatments are short, minimally invasive and capable of healing the damage that has been done to the disc. Stem cell therapy produces new disc cells inside the disc itself, allowing it to rebuild to a like-new condition. When treating degenerative disc disease, bone marrow is extracted from the patients hipbone and stem cells are filtered out using a centrifuge. Then stem cells are injected into the disc with the help of an x-ray. After this step, the patient is free to go home and begin the recovery process. Over the next few months to a year, patients will experience a lessening of back pain as the disc begins to restore itself. It is quite common for patients who have undergone stem cell injections to experience complete relief from back pain and a vast improvement in their overall quality of life.

Stem cells can also be used to enhance the effects of a spinal fusion surgery. A lack of useful new bone growth after this type of surgery can be a significant problem. This new technology helps patients grow new bone and avoid harvesting a bone graft from the patients own hip or using bone from a deceased donor. By avoiding these steps, patients are able to recover faster and prevent painful procedures.

A major component of stem cells is their ability to reinforce stronger, healthier healing in patients. Oftentimes, the body is in a weakened state following a surgical procedure and therefore more susceptible to developing infection. Stem cells unique ability to replenish themselves offers the body fresh, healthy cells that are not nearly as vulnerable to incurring infection so that the body can heal more quickly and effectively.

After undergoing a surgery and the rehabilitation process that follows, many patients are left with unsightly scars. These scars are often painful reminders of a traumatic event and, in some cases, cause self-consciousness or outright embarrassment due to their appearance. Stem cells have become an increasingly useful aid in ridding patients of unattractive scars so that they can fully recover from their injuries. Stem cells are useful in the treatment of scarring in three major ways: they carry anti-inflammatory properties that prevent excessive scarring, are capable of replenishing normal cells in the tissue through differentiation, and finally, stem cells dissolve the excess collagen in scar tissue by emitting large amounts of enzymes whose specific function is to dissolve scar tissue.

Click here to learnmore about stem cell therapy from WebMD.com.

The potential medical benefits of stem cell research are unparalleled in the healing and rejuvenating processes following a spinal procedure. Whether you are facing a major surgery or are considering your options concerning continued pain and physical limitations, knowing what options may be best for you is vital in the search for skilled medical care. Schedule an appointment with a laser spine surgeonto find out how stem cell therapy can be used to help you find a healthier and happier life.

Next, please read about disc replacement surgery.

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Cure Spinal Cord injury Research, therapies, treatments, 2018

By JoanneRUSSELL25

Update: January 2018

Background information:One of the biggest issues preventing recovery after achronicspinal cord injury is the scar that appears a few days or weeks after the injury and prevents any axon from growing away from the lesion area. One of the key scar reduction strategies involves using the Chondroitinase enzyme.

In this chapter we are also covering the therapeutic strategies that are used to neutralize growth inhibitors (often referred to as NoGo) after the spinal cord injury, and /or promote nerve growth.

The intrathecal delivery of the NoGo Trap protein delivery has shown axonal growth associated with a certain recovery of function by rats. It is reported to promote nerve sprouting and synaptic plasticity, as well as, to a lesser extent, axonal regeneration. The ReNetX company is now planning a clinical trial for cervical injury patients.

Input from Spinal Research, who initiated the project: since 2014, the CHASE-IT consortium has achieved several critical milestones by working on, and overcoming, many of the issues related to creating a safe gene therapy for chondroitinase:

-The gene for chondroitinase can now be expressed in an active form in human cells-Expression of chondroitinase in the spinal cord can now be controlled, switching it on and off using an inducible switch responsive to the antibiotic doxycycline-Treatment gives rise to improved walking and unprecedented upper limb function in clinically-relevant spinal cord injury models

-Demonstrate inducible chondroitinase gene therapy works in chronic injuries-Transfer the inducible gene therapy machinery developed in the lentiviral vector to the more clinically-acceptable Adeno-associated viral (AAV) vector-Eliminate any background expression of chondroitinase when system in the uninduced off state-Confirm chondroitinase-AAV retains comparable efficacy as chondroitinase-L

-UK:alternative delivery method for Chase. More info: here-CANADA:alternativedelivery method for Chase.-USA:studyof non-human primates.-USA: Rose Bengal Study by Dr. A. Parr (University of Minnesota). See January 2018 publication

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Spinal Cord Injury and Stem Cells | Cells4Life

By Dr. Matthew Watson

The spinal cord is a collection of nerve fibres and other tissues contained with the spine. The nerves within the spinal cord connect the peripheral nervous system to the brain forming the central nervous system. The spinal cord is essential for the transmission and reception of electrical messages to and from the brain to other areas of the body. Should the spinal cord become damaged, the impacts can be devastating or even fatal.

Preventable causes such as violence, falls and road traffic accents account for the majority of spinal cord injuries. Every year, between 250,000 and 500,000 people suffer a spinal cord injury globally. Unfortunately, those with a spinal cord injury are 2 to 5 times more likely to suffer premature death than those without.[1]

A spinal cord injury can affect anyone at any time and unfortunately there is currently no effective treatment available to those with a spinal cord injury.

The cost of spinal cord injury to the UK alone is estimated at 1 billion per annum.[2]

While there is currently no effective treatment for spinal cord injury available to the general public, stem cells could hold the key to successful spinal cord repair in the future. A British professor, Geoffrey Raisman, headed research which used stem cells to enable a paralysed man to walk again.

The research used a type of stem cell called olfactory ensheathing cells (OECs) from the nose of the patient and transplanted them into the spinal cord. OECs are specialist cells which form part of the sense of smell enabling nerve fibres in the olfactory system to continually renew. It was previously thought that severed nerve fibres in the spinal cord were unable to repair themselves. However, once OECs have been transplanted into the spinal cord it appears they facilitate the growth of the ends of severed nerve fibres and even enable them join together.[6]

In addition to Raismans research, Dr. Carlos Lima of Portugal had transplanted olfactory stem cells to treat spinal cord injury in over 100 patients. Lima and his team showed that a few patients were able to regain some motor function and sensation thanks to the transplanted olfactory stem cells.[7]

Promisingly, there are currently 38 clinical trials investigating the application of stem cells in spinal cord injury.[8]

The information contained in this article is for information purposes only and is not intended to replace the advice of a medical expert. If you have any concerns about your health we urge you to discuss them with your doctor.

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Stem Cell Treatments – Brain and Spinal Cord

By Sykes24Tracey

Because stem cells have the potential to generate cells designed to replace or repair cells damaged by spinal cord injury, advocates of stem cell research and treatment believe that the benefits far outweigh the negative aspects. Opponents of this research and treatment, however, typically bring up the issue of embryonic stem cells, which are harvested from embryos and fetal tissue. Accordingly, they feel the use of these embryonic stem cells is not moral or ethical. Because stem cells are harvested from embryos and fetal tissue, they feel it is not moral or ethical. Secondly, opponents are concerned about the health and safety of the participants in human stem cell research trials. It is important to note that non-embryonic stem cells, called somatic or adult stem cells, have recently been identified in various body tissues including brain, bone marrow, blood vessels, and various organ tissues.

Lets talk about how stem cell research could possibly impact spinal cord injury. Stem cell research came on the scene in 1998, when a group of scientists isolated pluripotent stem cells from human embryos and grew them in a culture. Since then, specialists have discovered that stem cells can become any of the 200 specialized cells in the body, giving them the ability to repair or replace damaged cells and tissues. While not yet known to have the diversification potential of embryonic stem cells, adult somatic cells act similarly and are generating excitement in the research and medical community.

When all is said and done, could stem cell treatment be the miracle cure for spinal cord injury and paralysis? Well, we dont really know. Because of all of the controversy, much of the evidence that shows stem cells can be turned into specific cells for transplantation involves only mice, whose cells are significantly different than human cells. Nevertheless, some initial research points to promising results. One hurdle that remains to be cleared is whether an immune response would reject a cellular transplant.

Ultimately, no one yet knows the extent to which stem cell treatment could help spinal cord injury and paralysis. Scientists remain hopeful, but currently there just hasnt been enough research done to substantiate any particular result. Additional research needs to be done before we have more definitive answers.

Again, we just dont know. Much of the answer depends upon whether the political process and moral debate continues to limitand put the hold onthe amount of research done. At this point its impossible to say for sure whenor even ifstem cells will be useful in the treatment of paralysis.

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Syrinx of the Spinal Cord or Brain Stem – Neurologic Disorders – Merck Manuals …

By raymumme

A syrinx is a fluid-filled cavity within the spinal cord (syringomyelia) or brain stem (syringobulbia). Predisposing factors include craniocervical junction abnormalities, previous spinal cord trauma, and spinal cord tumors. Symptoms include flaccid weakness of the hands and arms and deficits in pain and temperature sensation in a capelike distribution over the back and neck; light touch and position and vibration sensation are not affected. Diagnosis is by MRI. Treatment includes correction of the cause and surgical procedures to drain the syrinx or otherwise open CSF flow.

Syrinxes usually result from lesions that partially obstruct CSF flow. At least half of syrinxes occur in patients with congenital abnormalities of the craniocervical junction (eg, herniation of cerebellar tissue into the spinal canal, called Chiari malformation), brain (eg, encephalocele), or spinal cord (eg, myelomeningocele). For unknown reasons, these congenital abnormalities often expand during the teen or young adult years. A syrinx can also develop in patients who have a spinal cord tumor, scarring due to previous spinal trauma, or no known predisposing factors. About 30% of people with a spinal cord tumor eventually develop a syrinx.

Syringomyelia is a paramedian, usually irregular, longitudinal cavity. It commonly begins in the cervical area but may extend downward along the entire length of the spinal cord.

Syringobulbia, which is rare, usually occurs as a slitlike gap within the lower brain stem and may disrupt or compress the lower cranial nerve nuclei or ascending sensory or descending motor pathways.

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Spinal Chord Injury Stem Cell Therapy | NSI Stem Cell

By LizaAVILA

How Adipose Stem Cell Technology Develops Spinal Cord Injury Treatment

No matter where they may naturally be found in the body, Adult Stem Cells are like electricity. They are pure potential. When properly stimulated, stem cells become whatever type of cell the body needs: bone, blood, cartilage, muscle, nerve, and more. The results of studies like those published on CellTherapyJournal.org and reported on at MedScape.com state that stem cells, particularly Adipose-Derived Stem Cells, have great potential in the development of Stem Cell Therapy for Spinal Cord Injury.*

When a Spinal Cord Injury occurs, the resulting inflammation releases inhibiting factors that ultimately cause the fibers of nerve cells to retract. Scar tissue develops, effectively preventing a bridge to be formed across the area of injury. This, in essence, is what prevents healing and causes the debilitating effects after injury. But research has shown that Adult Stem Cells, particularly Adipose-Derived Stem Cells, have the potential for bridging the gap. Additionally, stem cells might excrete substances that reduce damaging inflammation. Already, trials involving Spinal Cord Injury Therapy via stem cells are producing remarkable effects.

Studies from around the world are reporting exciting results, from trial subjects undergoing stem cell therapy for spinal cord injury who regain the capacity to feel light touch to some who were able to walk for at least an hour with the aid of a walker. An improvement in bladder and bowel control was also reported.

Where To Find Stem Cell Therapy In The U.S.

No medical clinic is better equipped and keeps a closer eye on the very latest Stem Cell Treatments than NSI Stem Cell Center in Florida. Rest assured that we are poised and ready to offer stem cell Spinal Cord Injury Therapy at its earliest development. We are already providing therapies for neurological disorders such as Multiple Sclerosis and Parkinsons Disease, as well as many treatments for a growing list of other injuries, illnesses, and chronic conditions.

Well be happy to answer any of your questions regarding the advanced and exciting field of FDA guideline-compliant Stem Cell Therapy we practice. Call (877) 278-3623 or use our Contact Page. We have a FREE brochure waiting for you.

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Stem Cells & Spinal Cord Injuries – sci-info-pages.com

By Dr. Matthew Watson

Stem cell therapy can be defined as a part of a group of new techniques, or technologies that rely on replacing diseased or dysfunctional cells with healthy, functioning ones. These new techniques are being applied experimentally to a wide range of human disorders, including many types of cancer, neurological diseases such as Parkinson's disease and ALS (Lou Gehrig's disease), spinal cord injuries, and diabetes.

Coalition for the Advancement of Medical ResearchThe Coalition for the Advancement of Medical Research (CAMR) is comprised of nationally-recognized patient organizations, universities, scientific societies, foundations, and individuals with life-threatening illnesses and disorders, advocating for the advancement of breakthrough research and technologies in regenerative medicine - including stem cell research and somatic cell nuclear transfer - in order to cure disease and alleviate suffering.

Portraits of HopeVolunteer group of patients and their families and friends who believe that stem cell research has the potential to save the lives of those afflicted by many medical conditions, including spinal cord injury. Purpose is to show the faces and recount the stories of people who have such illnesses and present these portraits to federal and state legislators in request for government support.

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Paraplegic breakthrough using adult stem cells – WND

By raymumme

In an apparent major breakthrough, scientists in Korea report using umbilical cord blood stem cells to restore feeling and mobility to a spinal-cord injury patient.

The research, published in the peer-reviewed journal Cythotherapy, centered on a woman had been a paraplegic 19 years due to an accident.

After an infusion of umbilical cord blood stem cells, stunning results were recorded:

The patient could move her hips and feel her hip skin on day 15 after transplantation. On day 25 after transplantation her feet responded to stimulation.

Umbilical cord cells are considered adult stem cells, in contrast to embryonic stem cells, which have raised ethical concerns because a human embryo must be destroyed in order to harvest them.

The report said motor activity was noticed on day 7, and she was able to maintain an upright position on day 13. Fifteen days after surgery, she began to elevate both lower legs about one centimeter.

The studys abstract says not only did the patient regain feeling, but 41 days after stem cell transplantation, testing also showed regeneration of the spinal cord at the injured cite and below it.

The scientists conclude the transplantation could be a good treatment method for paraplegic patients.

Bioethics specialist Wesley J. Smith, writing in Lifesite.com, expressed enthusiasm about the apparent breakthrough, but also urged caution.

We have to be cautious, said Smith, a senior fellow at the Seattle-based Discovery Institute and a special consultant to the Center for Bioethics and Culture. One patient does not a treatment make.

The authors of the study note, writes Smith, that the lamenectomy the patient received might have offered some benefit.

But still, this is a wonderful story that offers tremendous hope for paralyzed patients, he said.

The fact that the patient has a very old injury, Smith added, makes the results even more dramatic.

Smith said he has known about the study for some time, but because I didnt want to be guilty of the same hyping that is so often engaged in by some therapeutic cloning proponents, I waited until it was published in a peer reviewed journal.

Like most breakthroughs using adult stem cells, this one has been completely ignored by the U.S. mainstream media, Smith pointed out.

Can you imagine the headlines if the cells used had been embryonic? he asked.

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Adult Stem Cell Success Story | Spinal Cord Injury | SCRF

By raymumme

(May, 2010) If there was ever a woman on a mission, its Laura Dominguez. Doctors once told her shed never walk again. And while shes not ready to run a marathon, shes already proving them wrong, with the best yet to come.

An oil spill on a San Antonio freeway is blamed for the car crash that sent Laura and her brother directly into a retaining wall one summer afternoon in 2001. Laura was just 16 years old at the time and the crash left her completely paralyzed from the neck down. Surgeons say she suffered whats known as a C6 vertebrae fracture that severely damaged her spinal cord.

I refused to accept their prognosis that I never would walk again and began searching for other options, says Laura. After stays in several hospitals for nearly a year, Laura and her mother relocated to San Diego, CA so that she could undergo extensive physical therapy. While in California, they met a family whose daughter was suffering from a similar spinal cord injury. They were also looking for other alternatives to deal with spinal cord injuries.

After extensive research and consultations with medical experts in the field of spinal cord injuries, they decided to explore a groundbreaking new surgical procedure using adult stem cells pioneered by Dr. Carlos Lima of Portugal.

The surgery involved the removal of tissue from the olfactory sinus area at the back of the nose--and transplanting it into the spinal cord at the injury site. Both procedures, the harvesting of the tissue and the transplant, were done at the same time. Laura was the tenth person in the world and the second American to have this procedure done and was featured in a special report by PBS called Miracle Cell.(Link to Miracle Cell (PBS) Episode)

Following the surgery she returned to California where she continued with the physical therapy regimen, then eventually returned home to San Antonio. Upon her return home, an MRI revealed her spinal cord was beginning to heal. Approximately 70% of the lesion now looked like normal spinal cord tissue. More importantly to Laura, she began to regain feeling in parts of her upper body and within six months of the surgery regained feeling down to her abdomen.

Improvements in sensory feelings have continued until the present time. She can feel down to her hips, and has regained feeling and some movement in her legs. Lauras upper body has gained more strength and balance and one of the most evident improvements has been her ability to stand and remain standing, using a walker, and with minimal assistance. When she stands she can contract her quadriceps and hamstring muscles.

Every week it seems Im able to do something new, something different that I hadnt done the week before, says Laura.

Now Lauras story is poised to take a new, potentially groundbreaking turn. In the Fall of 2009, she traveled again to Portugal where adult stem cells were extracted from her nose for culturing. As this story is written, she is preparing to fly back to Portugal where scar tissue at her injury site will be removed and her own adult stem cells injected in the area of her original wound.

The Laura Dominguez story is not complete. The next chapter may or may not yield the results she seeksbut no one can deny the determination and courage of Laura. For her part, she has one goal in mind: I will walk again.

We shall update this site and keep you informed on her progress.

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Spinal cord compression – Canadian Cancer Society

By Dr. Matthew Watson

The spinal cord is a column of nerve tissue. It runs from the brain stem down the back through the centre of the vertebrae, which are the bones of the spinal column. The nerves in the spinal cord carry messages (electrical signals) between the brain and the rest of the body. Spinal cord compression (also called cord compression) is a problem that occurs when something, such as a tumour, puts pressure on the spinal cord. The pressure causes swelling and means that less blood can reach the spinal cord and nerves.

Spinal cord compression is a serious condition that needs to be treated right away.

Spinal cord compression can be caused by any condition that puts pressure on the spinal cord. It can happen if the vertebrae are damaged or collapse. It can also develop if a tumour puts pressure on the spinal cord.

The most common cause of spinal cord compression in people with cancer is metastasis to the spine. About 60%70% of metastases to the spine occur in the middle part of the back, which is called the thoracic spine. About 20%30% of metastases happen in the lower back, or lumbosacral spine. Only about 10% of metastases happen in the upper back or neck area, which is called the cervical spine. About 30% of people with metastasis to the spine will have metastases in more than one area of the spine.

Any type of cancer can spread to the spine, but it is more common with the following cancers:

Symptoms of spinal cord compression can vary. They may be mild at first or pain may be the only symptom. As the tumour puts more pressure on the spine, the symptoms become worse and more serious.

Pain in the back or neck is a common symptom. It may feel like a band around the chest or abdomen. It can radiate, or spread out, over the lower back and into the buttocks or legs. It may also spread down the arms. The pain may be worse when you lie down.

Other symptoms of spinal cord compression include:

Your doctor will try to find the cause of spinal cord compression. This usually includes physical and neurological exams that include questions and tests to check brain, spinal cord and nerve function. Your doctor will also check your coordination and how well your muscles and reflexes are working.

Spinal cord compression is usually diagnosed by the following imaging tests:

If a centre doesnt have MRI or CT scans, the doctor may order myelography. During this procedure, an x-ray is taken after injecting a dye into the spinal canal. The spinal canal is the hollow space in the spinal column that contains the spinal cord.

Find out more about these tests and procedures.

Spinal cord compression needs to be treated right away to try to prevent permanent damage to the spinal cord. The goal of treatment is to give you the best quality of life possible. Treatments are used to:

You may be given one or more of the following treatments. Your doctor may also order physical therapy or other rehabilitation after treatment to help you maintain and improve your ability to move.

Corticosteroids are drugs that reduce swelling and lower the bodys immune response. They are used to quickly lower swelling and pressure around the spinal cord. They can also quickly relieve pain.

The healthcare team will usually start corticosteroids right away if they think you have cord compression. The dose is gradually lowered and then stopped if symptoms improve or if you start other treatments.

External beam radiation therapy is the most common treatment for spinal cord compression. It is a type of radiation therapy that uses a machine outside the body to direct radiation at a tumour and surrounding tissue. It is used to shrink a tumour pressing on the spinal cord.

You will start external beam radiation therapy as soon as possible after your doctor diagnoses cord compression. It is usually given as a short-course treatment, which means it is given for a short period of time. Treatments for most types of tumours can vary from a single treatment to daily treatments for 2 weeks. If you have lymphoma or multiple myeloma, you may need radiation therapy for up to 4 weeks. If you need surgery, radiation therapy may be given after surgery.

Surgery may be offered if the tumour doesnt respond to radiation therapy or if you already had radiation therapy. But surgery is an option for only a small number of people. Whether or not you can have surgery depends on the type of tumour, where the tumour is and how unstable the spine may be. Other factors include whether or not the specialized equipment and a trained neurosurgeon are available in your area and the overall prognosis of the cancer.

Surgery is used to remove as much of the tumour as possible. It is also used to stabilize the spine and relieve pressure within the spine.

The surgeon may remove parts of a vertebra to remove a tumour or relieve pressure on the spinal cord. Removing parts of a vertebra will not weaken the spine. The surgeon may place steel pins or rods to help stabilize the spine.

Your healthcare team may use drug therapy to treat the tumour. The type of drugs given will depend on the type of cancer. Chemotherapy may be used for certain types of cancer such as non-Hodgkin lymphoma (NHL) or lung cancer. Hormonal therapy and chemotherapy may be given after radiation therapy or surgery for other types of cancer such as breast or prostate cancer.

If your healthcare team thinks that you are at risk of developing spinal cord compression, they may prescribe bisphosphonates. These drugs stop the body from breaking down bone. They also help strengthen bones. Bisphosphonates are used to help protect bones in the spinal column against the effects of some cancers. Find out more about bisphosphonates.

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Levels of Spinal Cord Injury – Brain and Spinal Cord

By NEVAGiles23

Basic Spinal Cord Anatomy

To understand this confusion and what you are actually being told when your injury is described as being at a certain level, it is necessary to understand basic spinal anatomy. The spine and the spinal cord are two different structures. The spinal cord is a long series of nerve cells and fibers running from the base of the brain to shortly above the tailbone. It is encased in the bony vertebrae of the spine, which offers it some protection.

The spinal cord relays nerve signals from the brain to all parts of the body and from all points of the body back to the brain. Part of the confusion regarding spinal cord injury levels comes from the fact that the spine and the spinal cord each are divided into named segments which do not always correspond to each other. The spine itself is divided into vertebral segments corresponding to each of the vertebrae.

The spinal cord is divided into neurological segmental levels, meaning that the focus is on what part of the body the nerves from each section control. The spine is divided into seven neck (cervical) vertebrae, twelve chest (thoracic) vertebra, five back (lumbar) vertebrae, and five tail (sacral) vertebrae. The segments of the spine and spinal cord are designated by letters and numbers; the letters used in the designation correspond to the location on the spine or the spinal cord. For example:

The spinal cord segments are named in the same fashion, but their location does not necessarily correspond to the spinal segments location. For example:

The spinal cord is responsible for relaying the nerve messages that control voluntary and involuntary movement of the muscles, including those of the diaphragm, bowels, and bladder. It relays these messages to the rest of the body via spinal roots which branch out from the cord.

The spinal roots are nerves that go through the spines bone canal and come out at the vertebral segments of the spinal cord. Bodily functions can be disrupted by injury to the spinal cord. The amount of the impairment depends on the degree of damage and the location of the injury.

The head is held by the first and second cervical segments. The cervical cord supplies the nerves for the deltoids, biceps, triceps, wrist extensors, and hands. The phrenic nucleus (a group of cell bodies with nerve links to the diaphragm) is located in the C3 cord.

The thoracic vertebral segments compose the rear wall of the ribs and pulmonary cavity. In this area, the spinal roots compose the between the ribs nerves (intercostal nerves) which control the intercostal muscles.

The spinal cord does not travel the entire length of the spine. It ends at the second lumbar segment (L2). Spinal roots exit below the spinal cords tip (conus) in a spray; this is called the cauda equine (horses tail). Damage below the L2 generally does not interfere with leg movement, although it can contribute to weakness.

In addition to motor function, the spinal cord segments each innervate different sections of skin called dermatomes. This provides the sense of touch and pain. The area of a dermatome may expand or contract after a spinal cord injury.

The differences between some of the spinal vertebral and spinal cord levels have added to the confusion in developing a standardized rating scale for spinal cord injuries. In the 1990s, the American Spinal Cord Association devised a new scale to help eliminate ambiguities in rating scales. The ASIA scale is more accurate than previous rating systems, but there are still differences in the ways various medical specialists evaluate an SCI injury.

Dr. Wise Young, founding director of Rutgers W. M. Keck Center for Collaborative Neuroscience explains that usually neurologists (nerve specialists) will rate the level of injury at the first spinal segment level which exhibits loss of normal function; however, rehabilitation doctors (physiatrists) usually rate the level of injury at the lowest spinal segment level which remains normal.

For example, a neurologist might say that an individual with normal sensations in the C3 spinal segment who lacks sensation at the C4 spinal segment should be classified as a sensory level C4, but a physiatrist might call it a C3 injury level. Obviously, these differences are confusing to the patient and to the patients family. People with a spinal cord injury simply want to know what level of disability they will have and how much function they are likely to regain. Adding to the confusion is the debate over how to define complete versus incomplete injuries.

For many years, a complete spinal cord injury was thought of as meaning no conscious sensations or voluntary muscle use below the site of the injury; however, this does not take in to account that partial preservation of function below the injury site is rather common. This definition of a complete injury also failed to take into account the fact that may people have lateral preservation (function on one side).

In addition, a person may later recover a degree of function, after being labeled in the first few days after the injury as having a complete injury. In 1992, the American Spinal Cord Association sought to remedy this dilemma by coming up with a simple definition of complete injury.

According to the ASIA scale, a person has a complete injury if they have no sensory or motor function in the perineal and anal region; this area corresponds to the lowest part of the sacral cord (S4-S5). A rectal examination is used to help determine function in this area. The ASIA Scale is classified as follows:

At this point, if you are a patient with a spinal cord injury or the family member of a spinal cord injury patient you may be more confused than ever. How do these ratings apply to the daily life of someone with a spinal cord injury? A brief overview of the basic definitions may help.

This is the greatest level of paralysis. Complete C1-C4 tetraplegia means that the person has no motor function of the arms or legs. He or she generally can move the neck and possibly shrug the shoulders. When the injury is at the C1-C3 level, the person will usually need to be on a ventilator for the long-term; fortunately, new techniques may be able to reduce the need for a ventilator.

A person whose injury is at the C4 level usually will not need to use the ventilator for the long-term, but will likely need ventilation in the first days after the injury. People with complete C1-C4 quadriplegia may be able to use a power wheelchair that can be controlled with the chin or the breath. They may be able control a computer with adaptive devices in a similar fashion and some can work in this way. They can also control light switches, bed controls, televisions and so with the help of adaptive devices. They will require a caregivers assistance for most or all of their daily needs.

People with C5 tetraplegia can flex their elbows and with the help of assistive devices to help them hold objects, they can learn to feed and groom themselves. With some help they can dress their upper body and change positions in bed. They can use a power wheelchair equipped with hand controls and some may be able use a manual wheelchair with grip attachments for a short distance on level ground.

People with C5 will need to rely on caregivers for transfers from bed to chair and so forth, and for assistance with bladder and bowel management, as well as with bathing and dressing the lower body. Adaptive technology can help these people be independent in many areas, including driving. People with C5 tetraplegia can drive a vehicle equipped with hand controls.

People with C6 tetraplegia have the use both of the elbow and the wrist and with assistive support can grasp objects. Some people with C6 learn to transfer independently with the help of a slide board. Some can also handle bladder and bowel management with assistive devices, although this can be difficult.

People with C6 can learn to feed, groom, and bath themselves with the help of assistance devices. They can operate a manual wheelchair with grip attachments and they can drive specially adapted vehicles. Most people with C6 will need some assistance from a caregiver at times.

People with C7 tetraplegia can extend the elbow, which allows them greater freedom of movement. People with C7 can live independently. They can learn to feed and bath themselves and to dress the upper body. They can move in bed by themselves and transfer by themselves. They can operate a manual wheelchair, but will need help negotiating curbs. They can drive specially-equipped vehicles. They can write, type, answer phones, and use computers; some may need assistive devices to do so, while others will not.

People with C8 tetraplegia can flex their fingers, allowing them a better grip on objects. They can learn to feed, groom, dress, and bath themselves without help. They can manage bladder and bowel care and transfer by themselves. They can use a manual wheelchair and type, write, answer the phone and use the computer. They can drive vehicles adapted with hand controls.

People with T1-T12 paraplegia have nerve sensation and function of all their upper extremities. They can become functionally independent, feeding and grooming themselves and cooking and doing light housework. They can transfer independently and manage bladder and bowel function. They can handle a wheelchair quite well and can learn to negotiate over uneven surfaces and handle curbs. They can drive specially adaptive vehicles.

People with a T2-T9 injury may have enough torso control to be able to stand with the help of braces and a walker or crutches. People with a T10-T12 injury have better torso control than those with a T2-T9 injury, and they may be able to walk short distances with the aid of a walker or crutches.

Some can even go up and down stairs; however, walking with such an injury requires a great deal of effort and can quickly exhaust the patient. Many people with thoracic paraplegia prefer to use a wheelchair so that they will not tire so quickly.

People with sacral or lumbar paraplegia can be functionally independent in all of their self-care and mobility needs. They can learn to skillfully handle a manual wheelchair and can drive specially equipped vehicles. People with a lumbar injury can usually learn to walk for distances of 150 feet or longer, using assistive devices. Some can walk this distance without assistance devices. Most rely on a manual wheelchair when longer distances must be covered.

There are many other functional scales besides the ASIA scale, but it is the most frequently used. Neurologists find the NLOI (the Neurological level of injury) scale helpful; it is a simply administered test of motor function and range of motion. The Function Independence Measure (FIM) evaluates function in mobility, locomotion, self-care, continence, communication, and social cognition on a 7-point scale.

The Quadriplegic Index of Function (QIF) detects small, clinically significant changes in people with tetraplegia. Other scales include the Modified Barthel Index, the Spinal Cord Independence Measure (SCIM), the Capabilities of Upper Extremity Instrument (CUE), the Walking Index for SCI (WISCI), and the Canadian Occupational Performance Measure (COPM).

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Levels of Spinal Cord Injury - Brain and Spinal Cord

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Stories of Hope: Spinal Cord Injury | California’s Stem …

By Sykes24Tracey

Espaol

Katie Sharify had six days to decide: would she let her broken body become experimental territory for a revolutionary new approacheven if it was unlikely to do her any good? The question was barely fathomable. She had only just regained consciousness. A week earlier, she had been in a car crash that damaged her spine, leaving her with no sensation from the chest down. In the confusion and emotion of those first few days, the family thought that the treatment would fix Katie's mangled spinal cord. But that was never the goal. The objective, in fact, was simply to test the safety of the treatment. The misunderstanding a cure, and then no cure -- plunged the 23-year-old from hope to despair. And yet she couldn't let the idea of this experimental approach go.

Just days after learning that she would never walk again, that she would never know when her bladder was full, that she would not feel it if she broke her ankle, she was thinking about the next girl who might lie in this bed with a spinal injury. If Katie walked away from this experimental approachwhat would happen to others that came after her?

Her medical team provided a crash course in stem cell therapy to help Katie think things through. In this case the team had taken stem cells obtained from a five-day old embryo and converted them into cells that support communication between the brain and body. Those cells would be transplanted into the injured spines. Earlier experiments in animal models suggested that, once in place, these cells might help regenerate a patient's own nerve tissue. But before scientists could do the experiment, they needed to make sure the technique they were using was safe by using a small number of cells, too few to likely have any benefit. And that's why they wanted Katies help in this CIRM-funded trial. They explained the risks. They explained that she was unlikely to derive any benefit. They explained that she was just a step along the way. Even so, Katie agreed. She became the fifth patient in what's called a Phase I trial: part of the long, arduous process required to bring new therapies to patients. Shortly after she was treated the trial stopped enrolling patients for financial reasons.

That was in 2011. Since then, she has been through an intensive physical therapy program to increase her strength. She went back to college. She tried skiing and surfing. She learned how to make life work in this new body. But as she rebuilt her life she wondered if taking part in the clinical trial had truly made a difference.

"I was frustrated at first. I felt hopeless. Why did I even do this? Why did I even bother?" But soon she began to see how small advances were moving the science forward. She learned the steep challenges that await new therapies. Then in 2014, she discovered that the research she participated in was deemed to be safe and is about to enter its next phase, thanks to a $14.3 million grant from CIRM to Asterias Biotherapeutics. "This has been my wish from day one," Katie says.

"It gives me so much hope to know there is an organization that cares and wants to push these therapies forward, that wants to find a cure or a treatment," she says. "I don't know what I would do if I thought nobody cared, nobody wanted to take any risks, nobody wanted to put any funding into spinal cord injuries.

"I really have to have some ray of hope to hold onto, and for me, CIRM is that ray of hope."

For more information about CIRM-funded spinal cord injury research, visit our fact sheet.

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Stories of Hope: Spinal Cord Injury | California's Stem ...

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