Life After Spinal Cord Injury: Diagnosis to Recovery

Spinal cord injury (SCI) accounts for life-changing conditions that affect one’s movement, sensation, and other bodily functions. Globally, >15 million individuals are living with some grade of SCI [1]. The majority of the causes involve traumatic incidents like accidents, sports injuries, or violence. Individuals affected with SCI are prone to develop physical, psychological and emotional consequences and are at risk of debilitating life-threatening conditions. 

The emergence of advanced diagnostic modules, emergency care, rehabilitation and regenerative medicine has transformed the Spinal Cord Injury Treatment landscape. Conventional therapies focus on stabilising injury and preventing further decline in nerve function. Regenerative care in the form of stem cell therapy for spinal cord injury is widely explored to address the root cause. The current article explores SCI causes, symptoms, diagnostics, and possible treatment options for improving patients’ quality of life. 

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What Is A Spinal Cord Injury?

Spinal cord injury characterizes spinal cord damage that affects a bundle of nerve fibers that connects the brain with other body parts. The nerves are responsible for signal transmission. The injury can affect minor or major body functions. The spinal cord in the body accounts for major components of the central nervous system. It facilitates lanes for the traffic that leaves the brain to other body parts. With spinal cord injury, closure of these lanes causes severe consequences. In severe cases, an individual experiences paralysis. 

What Causes Spinal Cord Injury (SCI)?

Spinal Cord Injury Causes Involve: 

Traumatic

• Road accidents, motor vehicle crashes
• Falls
• Sports injuries
• Violence-related injuries

Non-Traumatic 

• Osteoporosis/ Osteopenia
• Syringomyelia (cyst or fluid-filled cavities within the spinal cord)
• Spinal tumour or cancer
• Infection at spinal cord, swelling or inflammation
• Restricted blood flow supply (ischemia)
• Autoimmune condition (MS, Guillain-Barré), genetics (Hereditary spastic paraplegia)

What Are The Different Types Of Spinal Cord Injury (SCI)?

Spinal Cord Injury Types are Subcategorized Based on Location and Severity. This Includes:

Location

• Cervical Spine: Neck section from the bottom of the skull to shoulder level
• Thoracic Spine: Stretches from upper back to below navel
• Lumbar Spine: Section of lower back that extends to the top of the buttocks
• Sacral Spine: Nerve root at tailbone

Severity

• Incomplete: SCI where some of the nerve signalling is disrupted
• Complete: Complete inhibition of nerve signalling, resulting in permanent loss of abilities due to injury

Severity And Neurological Classification

ASIA Impairment Scale Classifies SCI Types on Severity Basis. This Allows Spinal Cord Injury Identification from Clinical Lenses. The Grade Includes:

• Grade A: Complete loss of sensory and motor function
• Grade B: Sensory exists but no motor function
• Grade C: Motor function below neurological level
• Grade D: Motor function is preserved
• Grade E: Minor incidence, sensory and motor function remain intact

What Are The Common Symptoms of Spinal Cord Injury (SCI)?

Spinal Cord Injury Symptoms Involve:

• Motor: Paralysis, muscular dystrophy, weakness, spasticity
• Sensory: Pain, paresthesia (tingling, numbness or burning sensation)
• Autonomic: Bradycardia, hypotension, hypothermia, urinary or bowel incontinence, erectile dysfunction

How is SCI Diagnosed?

SCI Injury Diagnosis Involves a Multistaged Approach Including:

• Physical Examination
• Diagnostic tests including electromyography, nerve conduction tests
• Neurological examination
• Imaging like MRI, CT scan, X-ray

What Are The Current Treatment Options? 

Spinal Cord Injury Treatment Recommendations Depend on its Cause and Type. This Involves:

Emergency Management

• In case of traumatic injury, the priority is to immobilise the patient
• Surgery if required; the intent is to minimize pressure on the spinal cord
• Prevention of secondary injury

Medication

• Steroids or anti-inflammatory medication to manage swelling or inflammation
• Analgesic for pain management
• Medication for adequate bladder and bowel movement

Neuroregenerative Approach

• Stem Cell Therapy for Spinal Cord Injury enables addressing the problem’s root cause
• Tissue regeneration, repair, anti-inflammation and immunomodulation
• Neuroprotection and prevention of further damage

Rehabilitation/Long-Term Support

• Physiotherapy to support muscular strength
• Occupational therapy to support with daily life activities 
• Psychological support to mitigate the risk of depression or suicidal thoughts. As SCI patients undergo immense physical challenges and have dependency, they are more prone to stress, anxiety, or depression
• Assistive technologies or devices like splints, halos, traction, braces, or other supportive devices

Can Regenerative Medicine Change The Future of SCI Recovery?

Stem cell therapy for spinal cord injury is intended to restore the function of the damaged nerve.  Clinical research widely explores mesenchymal stem cells (MSCs) sourced from umbilical cord tissue/blood, adipose tissue, and bone marrow. The therapy intends to follow the following mechanism:

• Reduction of scarred tissue (glial scar), promoting axonal regeneration
• Modulates post-injury inflammation
• MSCs release various growth factors and cytokines, creating a supportive microenvironment to support surviving neurons
• Supports endogenous repair

How Stem Cells Support SCI?

The current preclinical and clinical studies reflect safety and tolerance of stem cell therapy for spinal cord injury. The recent evidence supports the potential of stem cell therapy (SCT) to target the SCI root cause. This includes:

• Support Regeneration and Repair Mechanisms: Stem cells release various signalling molecules, cytokines, and growth factors that support axonal regeneration. They intrinsically activate the body’s repair mechanism; they protect existing neurones and create a supportive microenvironment
• Anti-Inflammation and Immunomodulation: MSCs introduce paracrine signalling; they release various anti-inflammatory cytokines that counteract pro-inflammatory signalling. They modulate immune response and promote a stem cell supportive mechanism
• Neuroprotection and Angiogenesis: MSCs release various neurotrophic factors that protect the existing neurons. They release various growth factors like VEGF, FGF, etc. that support new blood flow formation. This supports adequate blood flow at the injury site 
• Safety and Tolerance: Although stem cell therapy for SCI is at an early stage of development. The current clinical outcome supports its efficacy and safety among the patients. Negligible adverse events were reported in the majority of the cases [2]. 

*NOTE: The outcome of stem cell therapy for spinal cord injury varies among patients. It depends on stem cell quality, injury severity, location, and the individual’s response. Advancells, India is a leading manufacturer and supplier of clinical-grade stem cells for various neurological conditions including SCI. The cells are provided with a Certificate of Authentication (CoA). 

Who Are Not The Correct Candidates for SCT?

Stem Cell Treatment is Not Recommended When:

• Presence of any active infection, especially closer to the injection site
• Individuals with active malignancies or recent history of cancer
• Candidates with uncontrolled systemic condition
• Individuals with structural disconnection; there can be realistic functional goals set that are supported with SCT

Conclusion 

Spinal Cord Injury can potentially account for different degrees of disability. The adequate treatment approach depends on the symptoms, their severity, and the individual’s suitability. The evolution of regenerative medicine has transformed the therapeutic landscape of SCI patients who intend to improve neuronal damage. Stem cell therapy outcomes depend on the level of injury, cell type quantity, isolation procedure, and individual factors. In future development, large-scale clinical trials are crucial to establish long-term treatment efficacy and safety. 

References

1. World Health Organization. Spinal cord injury. Geneva: World Health Organization; 2024 Apr 16. Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury 
2. Montoto-Meijide R, Meijide-Failde R, Diaz-Prado SM, Montoto-Marques A. Mesenchymal stem cell therapy in traumatic spinal cord injury: a systematic review. International journal of molecular sciences. 2023 Jul 20;24(14):11719. 

FAQ’s

Q- What are the SCI Symptoms?

SCI Symptoms include compromised mobility, numbness, muscle dystrophy, pain, breathing difficulties, and loss of appropriate bowel or bladder function. 

Q- What are the Treatment Options for SCI?

SCI Treatment includes emergency care, surgery, medication, assistive device introduction, physical or occupational therapy, speech therapy, oxygen support, regenerative medicine, etc. The type of treatment recommended depends on the symptoms, severity, and individual’s needs. 

Q- Can Stem Cell Therapy Help Individuals with SCI?

Yes, stem cell therapy for SCI has multiple actions. This includes supporting neuronal regeneration, repair mechanisms, anti-inflammation, immunomodulation, and creating supporting microenvironments for existing neurons.