Spinal Cord Injury

SPINAL CORD INJURY

Definition

The central nervous system comprises the brain and spinal cord. The spinal cord is a bundle of nerves that runs down in the spine in the middle of the back. It carries signals back and forth between the body and the brain. A spinal cord injury disrupts the signals.

So-called tracts in the spinal cord carry messages between the brain and the rest of the body. Motor tracts transmit signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.

Spinal cord injuries usually begin with a blow that fractures or dislocates the vertebrae, the bone disks that make up the spine. Most injuries don't cut through the spinal cord. Instead, they cause damage when pieces of vertebrae tear into cord tissue or press down on the nerve parts that carry signals. Below there is a Video, summarizing the most important information about the Spine.

Causes of spinal cord injuries are characterized as ‘traumatic’ or ‘non-traumatic.’ Traumatic injuries are caused by an abrupt traumatic hit to the spine which results in damage to one or more of the vertebrae, or a severing of the spinal cord. Non-traumatic injuries are the result of slow internal damage to the spinal cord region.

Spinal cord injuries are also defined as complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, a body is paralyzed below the injury. With an incomplete injury, there is, however, still some movement and sensation below the injury.

Additionally, the term paralysis from a spinal cord injury may be referred to as Tetraplegia, and Paraplegia. Tetraplegia is also known as quadriplegia, this means your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury, while Paraplegia affects all or part of the trunk, legs, and pelvic organs.

Surgical decompression of the spinal cord and surrounding nerves has been the go-to treatment of choice for spinal cord injury patients. Doctors also attempt to treat pain and inflammation with the use of nonsteroidal anti-inflammatory (NSAID) drugs.

Surgery may help to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may sometimes also be needed to stabilize the spine to prevent future pain or deformity.

Neither of these treatments, however, has recovered the neurologic deficit that spinal cord injury patients have as a result of the damage to the spinal cord.

Causes of spinal cord injuries are characterized as ‘traumatic’ or ‘non-traumatic.’ Traumatic injuries are caused by an abrupt traumatic hit to the spine which results in damage to one or more of the vertebrae, or a severing of the spinal cord. Non-traumatic injuries are the result of slow internal damage to the spinal cord region.

Spinal cord injuries are also defined as complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, a body is paralyzed below the injury. With an incomplete injury, there is, however, still some movement and sensation below the injury.

Symptoms

Symptoms may be mild, moderate, or life-threatening at the affected level of the spine. Any of the following symptoms may occur with a spinal cord injury:

  • Inability to move the extremities or walk
  • Pain, stiffness in the back or neck area.
  • Numbness, or burning sensation
  • Muscle spasms
  • Difficulty in balancing
  • Inability to feel pressure, heat, or cold
  • Loss of bladder or bowel control
  • Difficulty breathing

The main areas in which a person may suffer a spinal cord injury are the cervical, thoracic, and lumbar part of the spine. Sacral, the fourth part of the spine, does not contain spinal cord tissue. Therefore, though a person may cause damage to the sacral vertebrae or nerves, it will not damage the cord at that level.

Treatment

Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury. In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Urgent medical attention is critical to minimize the effects of any head or neck trauma. That's why treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

Surgical decompression of the spinal cord and surrounding nerves has been the go-to treatment of choice for spinal cord injury patients. Doctors also attempt to treat pain and inflammation with the use of nonsteroidal anti-inflammatory (NSAID) drugs.

Surgery may help to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may sometimes also be needed to stabilize the spine to prevent future pain or deformity.

Neither of these treatments, however, has recovered the neurologic deficit that spinal cord injury patients have as a result of the damage to the spinal cord.

Traditional Treatment

Urgent medical attention is critical to minimize the effects of any head or neck trauma. That's why treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

In the emergency room, doctors focus on:

  • Maintaining your ability to breathe
  • Preventing shock
  • Immobilizing your neck to prevent further spinal cord damage
  • Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty and formation of deep vein blood clots in the extremities

You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury.

If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

  • Medications. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement.It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, it's not a cure for a spinal cord injury.
  • Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.
  • Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
  • Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. Such experimental treatments are, e.g, FES, Functional Electric Stimulation via a computer and electrodes to give small bursts of electricity to paralyzed muscles. LLLT,  low-level laser therapy has the potential for reducing inflammation, regulating macrophage/microglia polarization, and promoting neuronal survival. Virtual Reality (VR) in the field of Neurotherapy some studies have shown that VR can “trick” the brain into believing that it is physically performing the actions being simulated in the VR environment.Robots of all kinds are sweeping the market these days, and they are also seen in the medical field. Researchers have put together a new, exciting, and promising way for paralyzed patients to ambulate. The use of wearable robotic devices is giving patients the ability to walk again.Last but not least, are investigational stem cell treatments, which in various anecdotal cases has shown encouraging results.
STEM CELL THERAPY

Stem cell therapies have been studied for some time now to overcome the difficulty to stimulate Neurons to regenerate. There are various anecdotal cases where clients improved their conditions considerably. We also have in our investigational, patient funded studies, experienced interesting improvements by using expanded Mesenchymal stem cells from Cord Blood, and we believe that stem cell treatment is one of the most interesting technologies to recover the neurological deficit of a spinal cord injury.

Until relatively recently (2005), experts believed that adults cannot grow new neurons. But as neuroscientist Sandrine Thuret explains humans can indeed generate new brain cells, a process called neurogenesis. This new science background is also used in our investigational stem cell therapy for spine cord injuries. Below a chart of present clinical trials with stem cells registered at clinicaltrials.gov.

Spinal Cord Injury is presently the second highest treatment activity next to patients treated for muscular dystrophy in our treatment partner clinic. All different types of injuries with complete or incomplete form and injuries at a variety of spinal regions have been treated.

There are various good anecdotal successful treatments as also shown in our testimonials.

TREATMENT PROTOCOL

Below there is the general protocol for spinal cord injuries. Please keep in mind that this is only an example and the injection and cell types may change depending on the patient’s condition. The types of injections used in the therapy are also dependent upon the injury’s severity.

Our medical team is recommending and using a CT-Guided Intraspinal Stem Cell Injection for patients with very old injuries or complete and severe incomplete injuries, but besides this injection, we also perform normal intravenous (IV) and Lumbar Puncture (LP) injections.

General Protocol:

Asking for detailed medical documents including but not limited to latest medical report, actual and former scans, CT or MRI or X-Ray (vertebral) and if applicable: EMG, SEP, MEP  from a patient.

Reviewing the submitted medical information by the relevant medical team to analyse the treatment possibility

In case of potential favourable review we suggest:

The intravenous (IV) and Lumbar Puncture (LP) injections and allows the stem cells to be placed more directly on the injury site for less severe cases

A CT-Guided Intraspinal Stem Cell Injection for patients with very old injuries or complete and severe incomplete injuries

In both cases, we are using mainly expanded (passage two only) mesenchymal stem cells from umbilical cord. The quantity of stem cells administered depends on the severity of the injury, and in some cases, we combine even autologous Mesenchymal stem cells from the patients with allogeneic mesenchymal stem cells from umbilical cord.

In case you are an international client and opting for a treatment in Delhi with our partner clinic we will support you with all formalities including Visa to enter and stay in India.

Quality of Stem Cells

Stem cells which are administered to patients, are certified in respect of quality and stem cell quantity and either autologous or are produced by our partner company´s own high-quality stem cell treatment and cry-preservation facility in Delhi. Our partner company is a licensed blood bank, has GMP facilities and is ISO certified and engaged in exporting it´s stem cells internationally for R&D and treatment activities. Each patient will receive a certificate of stem cells administered for his condition.

The stem cells are administered by licensed physicians into the affected joint(s) (intra-articular injection) and intravenously (IV). In certain circumstances, stem cells may also be administered intrathecally and/or intramuscularly. Extra intra-articular injections for multiple joints can be arranged as medical requirements dictate.

Point of Care Treatment

Stem cell treatments in the responsibility of a qualified physician in form of a "Point of Care" treatment is in many countries allowed. Point of Care treatment is a medical procedure performed in an ambulatory clinic setting by a physician with a written patient consent. Countries, having regulations accepting such a treatment includes the US, Panama, Mexico, a few European countries, Australia and most East Asian Countries, including India.

As stem cell treatments are personalized treatments, results from one patient cannot be transferred to another, although we have many anecdotal cases where the condition of patients had been improved considerately. SCI patients may experience improvements with our stem cell treatment in movement, strength, sensation, control (limb, bowel, and bladder), and even the ability to sweat.

A majority of spinal cord injury patients experienced most of the improvements after a 3-6 month period after the hospital discharge. As with any form of stem cell therapy, also with investigational Spinal Cord injury in our partner clinics, there is the possibility of minimal to no improvement, and we encourage patients and caregivers to maintain realistic expectations.

It appears that Point of Care treatment with stem cells may become the real medical alternative, as this treatment alternative has shown already very high safety profiles and very interesting and encouraging results in respect of improved quality of life.

Furthermore, science and technology are advancing at speed never seen before in human history. Until even relatively recently (2005), experts believed that adults cannot grow new neurons. But, as neuroscientist Sandrine Thuret explains in the below video, humans can indeed generate new brain cells, a process called neurogenesis.

This science background is also used in our investigational spinal cord injury stem cell therapy.

Side effects and Follow up

When it comes to side effects, our patients have not experienced serious side effects from the stem cells treatment, and we are monitoring the well-being of our patients not only in the first 24 hours but also later on regularly by a dedicated patient coordinator.

The reaction / side effects to stem cell treatments are rare and a few patients also with our treatments experienced so far the following but had been treated accordingly without further complications.

  • Fever
  • Headache
  • Leg Pain
  • Diarrhoea
  • Vomiting
  • Allergic Reactions

Our stem cell treatment does not end with the treatment in our partner clinics. We care about how you are doing after you return home. So, we will monitor your post-treatment progress on a regular basis and are your contact partner for any questions which will come up after the treatment. The regular follow-up via email, i.e., after 1, 3, 6, 12, 24 months, also helps us evaluate the effectiveness of our investigational treatments and improve our protocols based on observed outcomes even further.

Stem Cell Treatment and Regulatory

Stem cell treatment is considered by various regulatory agencies as a drug treatment and has to follow those regulations. Neither the FDA nor EMA has, besides a very few clinical trial based products, not approved any stem cell treatment except the since many years performed Leukemia treatments.

We are however not performing treatments according to the drug-related pathway. This is also expressed in CFR 21, § 1271.15b, stipulating "You are not required to comply with the requirements of this part if you are an establishment that removes HCT/P's from an individual and implants such HCT/P's into the same individual during the same surgical procedure."

Link: https://www.ecfr.gov/cgi-bin/text-idx?SID=4b5910947514770590380ccda1d1fb96&mc=true&node=se21.8.1271_115&rgn=div8

We are following the "Point of Care" pathway (1271.15b) in the responsibility of physicians and the relevant Medical Boards.  Furthermore, our international treatment protocols are based on IRB approved protocols on which basis many, even thousands of patients had been treated successfully.

Clinical Trials, Studies & General Information

According to ClinicalTrials.gov statistic, in November 2017 there had been 862 trials for Spinal Cord Injury registered. Only 41 studies (4.75 %) are mentioning stem cell treatment reviews.
Link: https://clinicaltrials.gov/ct2/results?cond=Spinal+Cord+Injuries&term=&cntry1=&state1=&Search=Search

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

. 2010; 3(4): 248–269. Published online 2010 Sep 7.
PMCID: PMC2971538

Bone marrow and umbilical cord blood human mesenchymal stem cells: state of the art
Arianna Malgieri,1 Eugenia Kantzari,2 Maria Patrizia Patrizi,3 and Stefano Gambardella1,4

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

ISSN: 0963-6897, Online ISSN: 1555-3892
DOI: http://dx.doi.org/10.3727/096368916X691411  Volume 25, Issue 11, pages 1925-1943

Phase I–II Clinical Trial Assessing Safety and Efficacy of Umbilical Cord Blood Mononuclear Cell Transplant Therapy of Chronic Complete Spinal Cord Injury

Hui Zhu*†; Waisang Poon‡; Yansheng Liu*†; Gilberto Ka-Kit Leung§; Yatwa Wong§; Yaping Feng*; Stephanie C. P. Ng‡; Kam Sze Tsang‡; David T. F. Sun‡; David K. Yeung‡; Caihong Shen*†; Fang Niu*†; Zhexi Xu*†; Pengju Tan*†; Shaofeng Tang*; Hongkun Gao*†; Yun Cha*; Kwok-Fai So¶#**; Robert Fleischaker††; Dongming Sun‡‡; John Chen**; Jan Lai**; Wendy Cheng**; Wise Young**‡‡

http://www.ingentaconnect.com/contentone/cog/ct/2016/00000025/00000011/art00002?crawler=true

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2009 Oct 15;285(1-2):67-77. doi: 10.1016/j.jns.2009.05.027. Epub 2009 Jun 24.
A comparison of autologous and allogenic bone marrow-derived mesenchymal stem cell transplantation in canine spinal cord injury.
Jung DI1Ha JKang BTKim JWQuan FSLee JHWoo EJPark HM.
https://www.ncbi.nlm.nih.gov/pubmed/19555980

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2013 Feb;15(2):185-91. doi: 10.1016/j.jcyt.2012.09.005.
Clinical analysis of the treatment of spinal cord injury with umbilical cord mesenchymal stem cells.
Liu J1Han DWang ZXue MZhu LYan HZheng XGuo ZWang H.
https://www.ncbi.nlm.nih.gov/pubmed/23321330

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2012;2012:921053. doi: 10.1155/2012/921053. Epub 2012 Mar 4.
Mesenchymal stem cell for prevention and management of intervertebral disc degeneration.
Longo UG1Papapietro NPetrillo SFranceschetti EMaffulli NDenaro V.
https://www.ncbi.nlm.nih.gov/pubmed/22550520

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2013 Oct;70(20):3871-82. doi: 10.1007/s00018-013-1290-8. Epub 2013 Mar 1.
Mesenchymal stem cells secretome: a new paradigm for central nervous system regeneration?  Teixeira FG1Carvalho MMSousa NSalgado AJ.
https://www.ncbi.nlm.nih.gov/pubmed/23456256

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 (PMID:22960115)   10.1016/j.brainres.2012.08.051
A combination of taxol infusion and human umbilical cord mesenchymal stem cells transplantation for the treatment of rat spinal cord injury.

 
SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication
 2011 Aug;20(8):1297-308. doi: 10.1089/scd.2010.0466. Epub 2011 Mar 17.
Safety of intravenous infusion of human adipose tissue-derived mesenchymal stem cells in animals and humans.
Ra JC1Shin ISKim SHKang SKKang BCLee HYKim YJJo JYYoon EJChoi HJKwon E.
https://www.ncbi.nlm.nih.gov/pubmed/21303266
SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2009 Oct;36(1):200-12. doi: 10.1016/j.nbd.2009.07.012. Epub 2009 Jul 23.
Human umbilical cord blood stem cells upregulate matrix metalloproteinase-2 in rats after spinal cord injury.
Veeravalli KK1Dasari VRTsung AJDinh DHGujrati MFassett DRao JS.
https://www.ncbi.nlm.nih.gov/pubmed/19631747

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2017 Apr 4;7(1):620. doi: 10.1038/s41598-017-00553-6.
Low-level laser facilitates alternatively activated macrophage/microglia polarization and promotes functional recovery after crush spinal cord injury in rats.
Song JW1Li K1Liang ZW1Dai C1Shen XF2Gong YZ3Wang S3Hu XY4Wang Z5.
https://www.ncbi.nlm.nih.gov/pubmed/28377600

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

Crit Care Med. 2010 Nov;38(11):2181-9
Authors: Hu SL, Luo HS, Li JT, Xia YZ, Li L, Zhang LJ, Meng H, Cui GY, Chen Z, Wu N, Lin JK, Zhu G, Feng H

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

PMID: 20711072 [PubMed – indexed for MEDLINE]
Transplantation of umbilical cord blood stem cells for treating spinal cord injury

Stem Cell Rev. 2011 Mar;7(1):181-94
Authors: Park DH, Lee JH, Borlongan CV, Sanberg PR, Chung YG, Cho TH

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2010 Nov;38(11):2181-9. doi: 10.1097/CCM.0b013e3181f17c0e.
Functional recovery in acute traumatic spinal cord injury after transplantation of human umbilical cord mesenchymal stem cells.
Hu SL1Luo HSLi JTXia YZLi LZhang LJMeng HCui GYChen ZWu NLin JKZhu GFeng H.
https://www.ncbi.nlm.nih.gov/pubmed/20711072

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

 2013 Aug 1;38(17):E1065-74. doi: 10.1097/BRS.0b013e31829839fa.
Bone marrow-derived mesenchymal stem cell transplantation for chronic spinal cord injury in rats: comparative study between intralesional and intravenous transplantation.
Kim JW1Ha KYMolon JNKim YH.
https://www.ncbi.nlm.nih.gov/pubmed/23629485

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

Stem Cell Therapy for Spinal Cord Injury: A Status Report

Laird Harrison - May 06, 2016
https://www.medscape.com/viewarticle/862775

SPINAL CORD INJURY  -  Stem Cell Research & Medical Publication

Can you grow new brain cells? Science say’s yes! by Sandrine Thuret, a neuroscientist
https://steemit.com/science/@mercysaidyes/can-you-grow-new-brain-cells-science-say-s-yes
https://www.youtube.com/watch?v=B_tjKYvEziI