What is Spinal Cord Injury?
Spinal cord injury (SCI) is defined as damage to the spinal cord that temporarily or permanently causes changes in its function. SCI is divided into traumatic and non-traumatic etiologies.
Traumatic SCI occurs when an external physical impact (for example, a motor vehicle injury, fall, sports-related injury or violence) acutely damages the spinal cord, whereas non-traumatic SCI occurs when an acute or chronic disease process, such as a tumour, infection or degenerative disc disease, generates the primary injury.
Traumatic spinal cord injury (SCI) is a major cause of disability in developed countries. The financial burden is significant in terms of direct health care costs as well as loss of economic productivity. Even small improvements in mobility and/or manual dexterity may substantially reduce these costs and improve quality of life. However, current therapeutic options remain limited and there is a need for more effective treatments to restore function in SCI patients.
The incidence of SCI varies worldwide. Among developed regions, the incidence of traumatic SCI is higher in North America (39 cases per million individuals) than in Australia (16 cases per million individuals) or western Europe (15 cases per million individuals), owing to higher rates of violent crime and self-harm.
By comparison, the prevalence of non-traumatic SCI has been estimated as 1,227 cases per million individuals in Canada and 364 cases per million individuals in Australia; reliable data from other countries are not available.
Traumatic SCI occurs more commonly in males (79.8%) than in females (20.2%). The age profile of individuals with a traumatic SCI has a peak between 15 and 29 years of age and another one in those >50 years of age. Traffic accidents are the primary cause of all traumatic SCIs in North America and accounted for 38% of injuries between 2010 and 1014.
What Causes SCI?
The most common causes of spinal cord injuries in the United States are:
- Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost half of new spinal cord injuries each year.
- Falls. A spinal cord injury after age 65 is most often caused by a fall.
- Acts of violence. About 12% of spinal cord injuries result from violent encounters, usually from gunshot wounds. Knife wounds also are common.
- Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10% of spinal cord injuries.
- Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.
What are Common Signs and Symptoms of SCI?
The ability to control your limbs after a spinal cord injury depends on 2 factors: where the injury occurred on your spinal cord and the severity of the injury.
The lowest part of your spinal cord that remains undamaged after an injury is referred to as the neurological level of your injury. The severity of the injury is often called “the completeness” and is classified as either of the following:
- Complete. If all feeling (sensory) and ability to control movement (motor) are lost below the spinal cord injury, it is called complete.
- Incomplete. If you have some motor or sensory function below the affected area, the injury is called incomplete.
Additionally, paralysis from a spinal cord injury can be referred to as:
- Tetraplegia. Also known as quadriplegia, this means that your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury.
- Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.
After the initial injury or condition stabilizes, the next step is to prevent secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections and blood clots.
The length of hospital stays depend on the condition and the medical issues the patient faces. One of the main treatments after the injury is rehabilitation or surgery when needed.
Overall, surgery aims to realign the spinal column, re-establish spinal stability and decompression (that is, relief of bony or ligamentous compression) of the spinal cord. Surgery typically involves open reduction and decompression paired with an instrumented fusion (for example, using implanted metal hardware) to stabilize the spinal column in an anatomical position. The extent of surgery is tailored to the anatomical site, as well as the severity and extent of injury.
Rehabilitation requires an interdisciplinary approach involving nurses, physicians, dieticians, psychologists, physiotherapists, social workers, recreation therapists, speech therapists, orthotists and child life specialists.
Rehabilitation can have significant effects on long-term health by helping patients to recover as much function as possible, prevent secondary complications, understand the extent of their injuries, cope with loss of independence and address other practical challenges, such as vocational and financial concerns.
New Treatment Options with Cellular Therapies
Because of the lack of current treatment options, new approaches have been made. Cellular therapies is one of them. The use of intravenous infusion of mesenchymal stem cells (MSCs) derived from bone marrow, umbilical cord and other sources, improves functional outcome in experimental models of SCI. The exact mechanism underlying these beneficial effects have not been fully elucidated, but potential mechanisms include neuroprotection and immunomodulation, induction of axonal sprouting, remyelination, restoration of the blood-brain/spinal cord barrier and enhancement of remote gene expression responses in the brain.
A group of researchers from Yale University and Japan recently published a study in the Journal of Clinical Neurology and Neurosurgery. In their study they included 13 patients with SCI. They reported no abnormal cell growth, central nervous system tumors or neurological deterioration on none of the patients after the therapy.
More than 50% of the patients had substantial improvements in key functions, such as the ability to walk or to use their hands. These results were observed just weeks after the stem cell infusion according to the report and no substantial side effects were reported.
The patients had sustained non-penetrating spinal cord injuries, in many cases from falls or minor trauma, several weeks prior to implantation of the stem cells. Their symptoms involved loss of motor function and coordination, sensory loss, as well as bowel and bladder dysfunction. The stem cells were prepared from the patient’s own bone marrow via culture protocol that took a few weeks in a specialized cell processing center. The cells were injected intravenously in this series, with each patient serving as their own donor.
Similar results with stem cells in patients with stroke increases the confidence that this approach may be clinically useful. Also, the idea that patients could be able to restore function after injury to the brain and spinal cord using stem cells has been a research topic for years. This and other studies prove that the therapy is feasible in humans and not only in animal models.
Stem Cell Therapy at Zignagenix
At our clinic, we use Umbilical cord-derived Mesenchymal stem cells from Wharton’s jelly tissue. Mesenchymal stem cells have been shown in different studies a tremendous potential to modulate the immune system, decrease inflammation in various tissues, and have a paracrine effect.
Following different research studies, one of the best ways to deliver stem cells to the brain and the affected areas in SCI is by performing an intrathecal injection. At the clinic, a physician specialized in Anesthesiology with years of experience in the field will perform an intrathecal injection with mesenchymal stem cells. This way, they can travel directly from the cerebrospinal fluid to the brain and the affected areas. Also, an intravenous infusion will be performed with a high dose of mesenchymal stem cells and exosomes to boost the therapeutic effect and increase the anti-inflammatory and regenerative properties of the cells.
Honmou, O., Yamashita, et al. Intravenous infusion of auto serum-expanded autologous mesenchymal stem cells in spinal cord injury patients: 13 case series. Clinical Neurology and Neurosurgery, 203, 106565. https://doi.org/10.1016/j.clineuro.2021.106565
Ahuja, C., Wilson, J., Nori, S. et al. Traumatic spinal cord injury. Nat Rev Dis Primers 3, 17018 (2017). https://doi.org/10.1038/nrdp.2017.18