How Does a Spinal Cord Injury Impact Daily Life

Spinal Cord Injury: A Neurobiological Overview

Spinal Cord Injury (SCI) doesn’t just affect movement; it disrupts the body’s entire communication system.  It entirely affects your daily life activities, including how you feel, function or live. 

Globally, more than 15 million individuals are affected with SCI, among whom more than 4.5 million individuals lived with long-term disability in 2021 [1]. The extent of SCI-associated impairment depends on the location and severity of the Spinal Cord Injury (SCI). The dysfunction of the autonomic nervous system affects multi-level function in the body. The common effect includes compromised movement, loss of bladder control, respiratory problems, inability to perform daily life activities, etc. Inappropriate management increases co-morbid conditions and premature mortality. 

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Neuroanatomy of the Spinal Cord and Functional Pathways

Understanding the spinal cord anatomical features and functional pathways helps in a detailed understanding of SCI and possible treatment. 

The spinal cord is a highly organized extension of the central nervous system (CNS) that facilitates communication between the brain and other body parts. It is divided into grey matter (neuronal cells) and white matter (myelinated fibers). The core function includes:

• Sensory (Ascending) and Motor (Descending) Tracts: Sensory tracts control the spinothalamic tract (pain, temperature) and dorsal columns (fine touch, vibration). Motor tracts control overall motor function in the body via controlling brain signals to skeletal muscle. The damage to these pathways disrupts signal transmission, loss of sensation and impaired motor control. 
• Autonomic Nervous System: SCI affects involuntary body function. It adversely affects the sympathetic and parasympathetic pathways. This dysregulates blood pressure, digestion, respiration, heart rate, and bladder and bowel function.
• Segmental Organization: SCI segments include cervical, thoracic, lumbar, and sacral. The injury can be incomplete (partial loss of motor and sensory function) and complete (complete disruption of motor function). Injury to specific segments triggers specific neurological deficits. For example, tetraplegia (cervical injuries affect upper & lower limbs), and paraplegia (thoracic or lumbar injury affects the lower body). Understanding function mapping is crucial in diagnosis and therapeutic accuracy. 

Etiology of Spinal Cord Injury

SCI causes are complex, ranging from physical trauma to non-traumatic mechanisms resulting in neural pathway disruption. The major causes involve:

• Trauma Cause: Caused by external force such as road accidents, sports injuries, falls, etc. Such events are likely to cause vertebral fractures or dislocation, resulting in spinal cord compression. 
• Non-Traumatic Cause: Complex medical conditions such as chronic inflammation, tumors, degenerative disease, etc. These causes have a slower onset that gradually leads to narrowing of the spinal canal. For instance, Spinal cord ischemia or hemorrhage obstructs adequate blood supply and compromises oxygen delivery. Certain infections like tuberculosis, bacterial abscesses or viral myelitis trigger chronic inflammation and cause tissue damage. Degenerative causes include cervical spondylitis myelopathy or intervertebral disc degeneration that progressively compresses the spinal cord. 
• Secondary Injury: The above triggers the SCI pathophysiological state. The secondary injury involves inflammation, excitotoxicity, oxidative stress, or blood flow disruption—the amplification of neural damage results in complete loss of sensory and motor function. 

What are Common Symptoms of SCI?

Spinal cord injury symptoms are subcategorized into three major subtypes:

• Sensory: Impaired signal carried from the brain to the sensory organs. The spinal cord controls tactile (touch) signals or self-positioning sense (proprioception). Example: Numbness, Pain, Tingling.
• Motor: Signal carried from the brain to the muscles. Example: paralysis, spasticity, weakness.
• Autonomic: Involuntary signals where thinking isn’t involved. Example: bradycardia, hypotension, hypothermia, urinary or faecal incontinence.

Clinical Manifestations and Systemic Dysfunctions

SCI possibly has severe complications that range from partial to complete loss of abilities in affected body parts. The major dysfunctions include:

• Tetraplegia: Paralysis down the neck region. Injury in the cervical segment
• Paraplegia: Paralysis affects the lower body. Major injury insights includes thoracic, sacral or lumbar region
• Autonomic dysreflexia: Injuries at the T6 or above region
• Neuropathic pain
• Neurogenic shock
• Pressure sores or sepsis
• Urinary tract infection
• Muscle atrophy
• Respiratory problems or cardiovascular risk
• Long-term metabolic complications or inflammatory changes

What is Spinal Cord Injury Treatment? 

Adaptation of adequate Spinal Cord Injury Treatment depends on the cause and symptom severity. Major option involves:

• Medication: Steroids or anti-inflammatory medication to manage swelling or pain around the spinal cord
• Traction: Restrict movement at a place
• Surgery: For relieving pressure on the spinal cord
• Supportive Devices: Splints, halos, braces or other devices that support motor function
• Long-Term Support: Physical therapy, occupational therapy, speech therapy. Supports motor and sensory functions
• Induced Hypothermia: Lowering body temperature potentially slows down damage, reduces inflammation and swelling
• Neurodegenerative Treatment: Stem cell therapy facilitates the regeneration of damaged cells. Enables neuroprotection, reduces inflammation, and supports other treatments

How is Regenerative Medicine Making a Difference?

Stem cell therapy is setting a new vision in SCI recovery and improving the quality of life of the patients. Though the implication is at an early stage, research findings and clinical reports have displayed positive outcomes. Mesenchymal stem cells have shown a prominent ability in the regeneration and repair process. The underlying mechanism is complex and integrates a multifactorial process. This includes:

• Regeneration: Stem cells release various growth factors that promote naïve neural cell regeneration. This replaces damaged or dead cells around injury sites. 
• Repair: The cells secrete various cytokines and growth factors that improve the surrounding microenvironment. They support growth, survival or healing of the injured area.
• Anti-Inflammation: Stem cells release anti-inflammatory cytokines (IL-10, PGE2, IDO) that modulate pro-inflammatory molecules’ effects. It significantly reduces inflammation. Reliefs pain and reduces swelling
• Immunomodulation: MSCs create a supportive microenvironment and modulate the immune system. This reduces the effective risk of immune rejection.

Preclinical and clinical studies have reflected the safety and tolerance of MSCs among SCI-suffering patients. The result varies among individuals depending on multiple factors. For instance, the efficacy of the therapy depends on certain factors like the quality of stem cells, source, isolation conditions, severity of the SCI, and the patient’s response. 

*NOTE: Advancells, India, is one of the renowned stem cell research laboratories that isolates and supplies stem cells for various neurological and chronic diseases, including spinal cord injury.

Adaptive Technologies, Neurorehabilitation, and Future Directions

Spinal cord injury care intends to improve trauma, address injury complications, introduce regeneration and provide rehabilitation. The current treatment approaches focus on management and relieving symptoms. While the future approach intends more rigorous measures.  

Development of smart rehabilitation robotic devices supports gait rehabilitation (hybrid assistive limb, Lokomat, ReWalk), hand and arm mobility (ArmeoPower spring), and hybrid neuromodulation. Regenerative medicine has shown potential curative ability. In the future, large-scale clinical trials with Stem Cell Therapy for Spinal Cord Injury are required to establish long-term efficacy and safety. 

References

1. World Health Organization. Spinal cord injury. Geneva: World Health Organization; 2024 Apr 16. Available from: Spinal cord injury fact sheet 
2. Hu X, Xu W, Ren Y, Wang Z, He X, Huang R, Ma B, Zhao J, Zhu R, Cheng L. Spinal cord injury: molecular mechanisms and therapeutic interventions. Signal transduction and targeted therapy. 2023 Jun 26;8(1):245. 

FAQ’s

Q- What are Spinal Cord Injury Types?

Spinal cord injuries are subcategorized into two subtypes: i) By location- Cervical spine, thoracic spine, lumbar spine, and sacral spine; ii) By severity- Incomplete, Complete.

Q- Does Stem Cell Therapy Cure Spinal Cord Injury?

Preclinical and Clinical evidence have supported the safety and efficacy of stem cell therapy for SCI patients. The major outcomes include a significant reduction of pain, inflammation and swelling.

Q- Can SCI be Completely Cured?

The current SCI treatment regimen does not promise a complete cure. The development of stem cell therapy potentially supports curative concepts. Regenerative of naive cells and inducing regulated repair mechanisms can aid in the cure of the patients.