Current and future medical therapeutic strategies for the functional repair of spinal cord injury

Abstract

Spinal cord injury (SCI) leads to social and psychological problems in patients and requires costly treatment and care. In recent years, various pharmacological agents have been tested for acute SCI. Large scale, prospective, randomized, controlled clinical trials have failed to demonstrate marked neurological benefit in contrast to their success in the laboratory. Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. Recently, attempted cellular therapy and transplantations are promising. A better understanding of the pathophysiology of SCI started in the early 1980s. Research had been looking at neuroprotection in the 1980s and the first half of 1990s and regeneration studies started in the second half of the 1990s. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs, and minimize the secondary damage caused by compression of the spinal cord after trauma. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.

Keywords: Cellular treatment; Management; Pharmacological treatment; Spinal cord injury; Trauma; Treatment.

Figure 1

Major mechanisms of cell death are ischemia, intracellular calcium deposition, apoptosis. Pharmacological agents may intervene in these mechanisms at different stages shown in boxes (From Dumont RJ).

Figure 2

Role of vascular effects, inflammation, interstitial edema, glutamate release, cord compression and reperfusion which underlie the spinal cord injury are shown. Pharmacological agents may be useful at foci which are demonstrated in boxes (From Dumont RJ).