Once spinal cord injury was thought to be irreversible, with the emergence of advanced regenerative medicine, new possibilities for recovery have emerged.
Spinal cord injury (SCI) deals with disrupted signals between the brain and body due to damage in the spinal cord. Individuals with SCI lose their independence, which invokes mental, social, and emotional side effects. The range of interdependence depends on the position and severity of the injury.
Spinal Cord Injury Recovery depends on careful consideration of the severity and integration of personalized care based on an individual’s needs.
What You Must Know About SCI?
SCI leads to nerve fiber damage in the injured areas. The neurological signal that passes from the brain to the specific organ is compromised. It leads to specific organ dysfunction or complete paralysis.
What are SCI Types?
SCI Completeness Depends on the Neurological Level of Damage. It Is Subcategorized As:
- Complete: Inability to control movement or feelings
- Incomplete: Partial inability to control movements. Partial or incomplete SCI have various degrees of effect
SCI Leads to Loss of Muscular Strength, Leading to Restrictive Movement (Paralysis). Paralysis Can Affect:
- Quadriplegia: Both the body’s upper (arms, shoulder) and lower (pelvic region, legs) are affected. Also known as tetraplegia
- Paraplegia: Lower proximity of the body is completely or incompletely affected (legs, trunk, pelvic region)
Types of Spinal Cord Injury
What Causes SCI?
SCI Can Occur Due to Both Internal and External Trauma. The Major Causes Include:
- Traumatic: Vehicle Accidents, sports injuries, falls, Violence
- Non-Traumatic: Pressure sore, blood clots, tumours, arthritis, inflammation, osteoporosis, infection
What are the Symptoms?
The Common Symptoms Include:
- Paralysis, or complete loss of muscle strength
- Sensory losses
- Compromised bladder or bowel control
- Muscle spasm or stronger reflexes
- Intense pain or aching sensation, pressure in the back of the neck, back or head
- Change in sexual sensitivity or function
- Breathing difficulties
- Lack of coordination
What are the Major Complications?
SCI-Associated Complications Can Vary Among Individuals. This Includes:
- Breathing: If the nerves related to the chest or stomach muscles are affected
- Blood Flow: SCI can lead to orthostatic hypertension (low blood pressure during sitting or lying down). Swelling in arms or legs characterized by blood clots, pulmonary embolus, or deep vein thrombosis. Life-threatening, intense shortness of breath can occur in others (autonomic dysreflexia)
- Bladder & Bowel Function: SCI can compromise the brain’s ability to regulate bladder or bowel function. The kidneys store excess fluid, or the stomach and intestine cannot control bowel movements. Increase risk of infection.
- Pain: SCI can cause internal inflammation, which leads to muscle spasm or joint pain. Nerve pain can also occur.
- Depression: Loss of independence and pain affects the psychological and emotional wellbeing of the person
SCI-Associated Complications [2]
What are the Established Treatment Strategies for SCI?
How is SCI Diagnosed?
The First Step is Spinal Cord Injury Diagnosis for Effective Management of Dysfunction. The Diagnosis Strategies Include:
- Physical examination of the patient
- Imaging includes X-rays, CT scan or MRI
How is SCI Treated?
The First Focus is to Prevent Additional Injury and Manage the Symptoms Efficiently. The Treatment Includes:
- Emergency Stabilization: This includes restricting movement (immobilization), maintaining breath, managing blood pressure, and preventing shock
- Preventing Blood Clots: DVT is common with SCI. Clinicians take measures to prevent DVT occurrence. In case DVT is reported, immediate steps are taken for clot removal (anticoagulants, thrombolytics)
- Surgery: Involves the removal of foreign objects, broken bones, herniated disks, or broken vertebrae.
- Rehabilitation: The care regime involves a multidisciplinary team. SCI does not get cured with short-term treatment. Patients required an extensive treatment regimen with involvement of a physical therapist, occupational therapist, psychologist, nurse, dietician, and family members.
- Palliative Care: Medicines are recommended to combat side effects and manage symptoms. This includes managing pain, muscle spasm, helping with bladder and bowel control, etc.
Can Regenerative Medicine Make a Difference for SCI Patients?
Stem Cell Therapy for spinal cord injury has emerged as a new hope for a cure. Although the research and clinical implications are at an early stage, they possess the ability to target the problem at the cellular and molecular levels.
The Focus is on axon or damaged nerve regeneration present between the brain and body. It aids in the elimination of intense pain, muscular cramps, or sensation loss. Stem cells enable the regeneration or restoration of visceral motor neurons and adult astrocytes. They boost the natural repair mechanism of the individuals by releasing and stimulating repair mechanism signals in the body. Researchers have widely explored mesenchymal stem cells (MSCs) due to their regenerative potential and paracrine effect.
One might think that Stem Cell Therapy for Spinal Cord Injury can introduce a complete cure. However, it is crucial to understand that stem cells undertake supportive mechanisms to heal the cure. In fact, the key mechanism by which it supports recovery is multifold.
What is the Science Behind Stem Cell Therapy for SCI?
Stem Cells’ action for spinal cord injury recovery is a complex process. It intends to restore tissue functionality and boost healing. The key mechanisms involved are:
- Neural Repair: MSCs release various cytokines, growth factors, and signalling molecules. They boost the body’s natural repair mechanism. It supports surrounding cells’ survival, repairs the damaged cells, and creates a supportive microenvironment.
- Immunomodulation: MSCs modulate immune response, releasing various anti-inflammatory cytokines (IL-10, TGF-β, IL-4), and modulating the effect of pro-inflammatory molecules (IL-1β, IL-6, TNF-α). This is crucial as pro-inflammatory cytokines derive secondary complications. Aids in pain management, inflammation, and muscle spasms
- Preventing Secondary Damage: Stem cells release various neurotrophic factors that support the neural environment. Supports psychological effect, aids in sensory recovery.
- Neural Regeneration: The cytokines and signalling molecules promote the revival of damaged cells. It supports neural regeneration that can potentially remove dead or damaged cells. It helps in function restoration [1]
How Does Clinical Evidence Support the Claim?
Currently, Preclinical and clinical evidence have marked the safety and tolerance of stem cells in the case of SCI patients. The long-term report outcome via clinical trials on spinal cord injury recovery is still emerging. The data focused on patients’ outcomes reflected:
- Improvement in mobility
- Improvement in sensory outcome
- Protection of nerve tissue
- Reduced inflammation
- Promote remyelination [1, 2]
Is SCI Treatment Available in India?
With growing research and clinical interest, India has transformed into a hub for medical tourism. The key reasons include effective availability of the infrastructure, renowned and experienced clinicians, effective cost management, and long-term rehabilitation facilities.
Spinal Cord Injury Treatment in India is widely evolving as supportive measures. This means adaptation of a combinational approach (stem cell therapy with conventional treatments). Spinal cord injury recovery is being maximized with increased collaboration between clinicians and stem cell researchers. However, the outcome’s success depends on certain factors:
- Quality of the stem cells, cell types, and isolation method
- Dose, timings, and administration conditions
- Administration route, through the best administration route is not defined, yet reports reflect better outcomes with the intrathecal and intraspinal route over the intra-arterial or intravenous route [2]
- An individual’s health response affects the overall recovery of the patient.
*Advancells, India, is a leading stem cell culture laboratory that supplies clinical-grade stem cells for various chronic disease conditions. The cells are isolated and maintained in regulated laboratory conditions and undergo stringent quality checks.
Conclusion
Spinal cord injury recovery is subject to a targeted treatment approach along with long-term rehabilitation. With the emergence of stem cell therapy, the curative possibilities are on the horizon. It is crucial to adapt evidence-based treatment decisions and multidisciplinary care for long-term effective management.
References
- Zeng CW. Advancing spinal cord injury treatment through stem cell therapy: a comprehensive review of cell types, challenges, and emerging technologies in regenerative medicine. International journal of molecular sciences. 2023 Sep 20;24(18):14349.
- Yamazaki K, Kawabori M, Seki T, Houkin K. Clinical trials of stem cell treatment for spinal cord injury. International journal of molecular sciences. 2020 Jun 2;21(11):3994.
FAQ’s
Q- Does SCT Support SCI Recovery?
Stem cell therapy supports spinal cord injury recovery via supporting nerve repair, reducing inflammation, and boosting functional ability. However, the long-term effect is still under investigation.
Q- How is SCI Diagnosed?
Spinal cord injury diagnosis involves neurological examination. This includes physical examination, imaging (MRI, CT-scan, X-ray), and other laboratory testing. It is crucial to diagnose both primary and secondary complications for adequate treatment.
Q- Is Stem Cell Therapy for SCI Available in India?
Spinal cord injury treatment in India has evolved in the current time. Several hospitals and research centers are collaborating with researchers to adapt combination treatment approaches for better recovery outcomes. The treatment implications are yet at the clinical trial stage.
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