In the subacute and chronic phases, a fluid-filled lentiform-shaped cavity or cyst forms in the center of the cord, with surrounding hypertrophic astrocytes and macrophages. Oligodendrocytes and neurons die, resulting in axonal demyelination and disruption of synaptic transmission. The primary and secondary injury mechanisms involve edema, hemorrhage, inflammation, apoptosis, necrosis, excitotoxicity, lipid peroxidation, electrolyte imbalance, ischemia/vasospasm, and blood vessel occlusion. The diagram shows a composite of pathophysiological events occurring after SCI, including the acute (e.g., edema and hemorrhage), subacute (e.g., inflammation), and chronic (e.g., cavitation) phases. However, neuroprotective agents alone may be insufficient to promote repair in major SCI where there is extensive tissue loss. Other neuroprotective agents with promising results in experimental animals are now being investigated in clinical SCI trials, including riluzole, a sodium channel blocker, and minocycline, an antiinflammatory agent ( 1, 18). Many SCI centers have stopped using steroids ( 17). Methylprednisolone demonstrated some neuroprotective effects in early experimental and clinical studies ( 15, 16), but its use is controversial because of limited efficacy and harmful side effects. Currently, there is limited pharmacotherapy for SCI patients. Acutely injured patients often require intensive care monitoring to treat cardiovascular instability and respiratory insufficiency. Acute treatment often involves surgical management, such as decompression, spinal stabilization, or realignment of displaced vertebrae ( 14) to prevent further injury from impingement on the spinal cord. The ASIA Impairment Scale (AIS) ranges from A to E, where A is a complete SCI and E denotes normal sensory and motor function. This review builds on several excellent previous reviews ( 2– 8) and discusses the incidence and pathophysiology of SCI as well as the key experimental and clinical stem cell strategies for SCI.Įpidemiology, etiology, incidence, and prevalence of SCIĪssessment of therapy in patients has improved markedly due to the development of the American Spinal Injury Association (ASIA) grading scale and quantitative scores of sensory and motor function now used worldwide to assess the severity of SCI and response to treatment ( 1). Stem cell therapy offers several highly attractive strategies for spinal cord repair, including replacement of damaged neuronal and glial cells, remyelination of spared axons, restoration of neuronal circuitry, bridging of lesion cavities, production of neurotrophic factors, antiinflammatory cytokines, and other molecules to promote tissue sparing and neovascularization, and a permissive environment for plasticity and axonal regeneration. Unfortunately, neurological recovery is limited, and most SCI patients still face substantial neurological dysfunction and lifelong disability. Current treatment includes surgery to decompress and stabilize the injury, prevention of secondary complications, management of any that do occur, and rehabilitation. Despite major advances in the medical and surgical care of SCI patients, no effective treatment exists for the neurological deficits of major SCI ( 1). When cancer is confined to the lung, the survival rate after five years is 49 percent but only 2 percent live five years if it has spread to other organs.Spinal cord injury (SCI) is a devastating condition, with sudden loss of sensory, motor, and autonomic function distal to the level of trauma. (AP Photo/Stuart Ramson, FILE) Stuart Ramson / AP 9, 2005, that she been diagnosed with lung cancer, and is currently undergoing treatment. The widow of actor Christopher Reeve confirmed in a statement Tuesday Aug. Christopher Reeve poses for photographers with his wife Dana as he arrives at the 13th annual Christopher Reeve Paralysis Foundation gala event in New York, in this file photo. Scott Swanson, chief of thoracic surgery at Mount Sinai Medical Center in Manhattan, said that depending on the extent of the cancer, Reeve would be treated with surgery, chemotherapy, radiation or a combination. She did not say where she is being treated.ĭr. The Reeves have a 13-year-old son, Will.ĭana Reeve, chairwoman of the Christopher Reeve Paralysis Foundation, said Tuesday that her lung cancer was recently diagnosed and is being treated, but she did not reveal the extent of the cancer or her prognosis, except to say that she and her doctors were optimistic. “As always, I look to him as the ultimate example of defying the odds with strength, courage, and hope.”Ĭhristopher Reeve, the star of the “Superman” movies who was paralyzed in a horse-riding accident in 1996, died last year. “Now, more than ever, I feel Chris with me as I face this challenge,” said the 44-year-old actress.
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