Spinal Cord Injury

Handbook of Clinical Neurology 3rd Series

Foreword

Preface

List of contributors

Chapter 1. Development and maturation of the spinal cord

Gross embryology

Cellular and molecular embryology of the spine

Spinal cord maldevelopment

Conclusion

References

Chapter 2. Anatomy and biomechanics of the spinal column and cord

Introduction

Biomechanics: the basic concepts

Biomechanics of spinal column failure

Biomechanics of spinal cord injury

Conclusions

References

Chapter 3. Clinical diagnosis and prognosis following spinal cord injury

Introduction

Assessing injury severity following spinal cord injury

Natural recovery following traumatic spinal cord injury

Ambulation and function following spinal cord injury

The role of imaging for prognosis and functional recovery

References

Chapter 4. Clinical neurophysiology in the prognosis and monitoring of traumatic spinal cord injury

Introduction

Evaluation of sensory function

Evaluation of motor function

Autonomic evaluation

Conclusions

References

Chapter 5. Concepts of aging with paralysis

Introduction

Pathophysiology of the aging nervous system

Etiology and clinical presentation of spinal cord injury in elderly subjects

Complications and mortality

Influence of age on outcome and length of stay for rehabilitation

Aging following a spinal cord injury

References

Chapter 6. Advanced MRI strategies for assessing spinal cord injury

Introduction

Assessment of macromolecular composition, tissue orientation, and organization

Functional and metabolic markers for tissue health

What to do when the therapeutic intervention requires placement of metal hardware for stabilization

Final comments – sensitivity/specificity

Conclusion

References

Glossary of acronyms and abbreviations

Chapter 7. Advances in the management of spinal cord and spinal column injuries

Epidemiology

Initial Management and Evaluation

Neurological Examination

Imaging

Classifications of Injuries to the Spine

Medical Management of Spinal Cord Injuries

Pharmacological Adjuncts in Spinal Cord Injury: Nascis and Sygen^® Studies

Surgical Management of Spinal Cord and Spinal Column Injuries

Surgical Treatment of Spinal Cord Injuries

Surgical Treatment of Spinal Column Injuries

Advances in Surgical Treatment of Spinal Cord and Spinal Column Injury

Conclusion

References

Chapter 8. Spinal cord injuries in children and adolescents

Epidemiology

Pathophysiology

Medical issues

Psychosocial issues and sexuality

Surgical

Summary

References

Chapter 9. The changing landscape of spinal cord injury

Methylprednisolone trials during acute spinal cord injury

Early spinal decompression and stabilization

Spinal cord injury-related complications

Pulmonary dysfunction

Autonomic nervous system disruption

Venous Thrombosis And Thromboembolism

Hypercalcemia After Spinal Cord Injury

Bone Loss

Heterotopic Ossification

Pressure Ulcers

Conclusion

References

Chapter 10. Surgical treatments to restore function control in spinal cord injury

Introduction

Spinal cord lesions and implications for reconstruction

Desirable patterns of hand usage

Example objectives for hand and upper limb reconstruction

Reconstructive procedures

Management of contracture

Contracture release and osteotomy examples

Surgical restoration of function

Functions to restore

Concepts in surgical restoration

Shoulder function

Elbow function

Forearm function (rotation)

Lateral pinch (key pinch)

Palmar grasp and release

Two-staged hand reconstruction

Current clinical and research trends

Evaluation of clinical outcome

Conclusions

References

Chapter 11. Advances in the rehabilitation management of acute spinal cord injury

Introduction

Trauma rehabilitation

Cardiovascular and pulmonary assessment and management

Musculoskeletal sequelae and treatment

Early management of pain

Bladder, bowel, and sexual function

Mobilization and functional training

Adaptive technology

Adjustment and support to the patient and family in the acute phase

References

Chapter 12. Spasticity

Introduction

Clinical signs: passive condition

Nonfunctional movement: active muscle

Functional movement: walking

Therapeutic consequences

Specific treatment approaches

Conclusions

References

Chapter 13. Disordered cardiovascular control after spinal cord injury

Overview of the clinical problem: from the acute to the chronic phases

Pathophysiology of cardiovascular dysfunction after spinal cord injury

Characteristics and causes of orthostatic hypotension after spinal cord injury

Causes and characteristics of autonomic dysreflexia

Cardiovascular control during sexual activity after spinal cord injury

Cardiovascular responses to exercise after spinal cord injury

New recognition of the need for autonomic evaluations following spinal cord injury

References

Chapter 14. New concepts in the prevention of pressure sores

Introduction

Assessing risk factors before pressure sores develop

Devices to prevent pressure sores

Clinical care to prevent pressure sores

Summary

References

Further reading

Chapter 15. Functional electrical stimulation for bladder, bowel, and sexual function

Introduction

Physiological principles

Clinical practice

Combined control of voiding and continence

Future prospects for restoring full control of bladder, bowel, and sexual function

References

Chapter 16. Evidence-based therapy for recovery of function after spinal cord injury

Physical rehabilitation

Locomotor training

Locomotor training using robotic assistance

Functional electrical stimulation during walking in individuals with spinal cord injury

Summary

References

Chapter 17. Functional electrical stimulation

Introduction

Indications

Surgical techniques

Weaning from the ventilator with a pacer: key points

Results

Conclusion

References

Chapter 18. Spinal cord stimulation

General introduction

Epidural electrical spinal cord stimulation

Intraspinal microstimulation

Summary

Acknowledgments

References

Chapter 19. Promoting optimal functioning in spinal cord injury

Introduction

Key principles and models in psychological care of persons with spinal cord injury

Areas of clinical focus

Assessment

Psychological intervention

Implications for neurologists and rehabilitation professionals

References

Chapter 20. The changing field of rehabilitation

Introduction

Activity

Activity-based restoration therapies

Future directions

References

Chapter 21. The longitudinal spinal cord injury

Introduction

Experimental injuries

Clinical injury

Comments

References

Chapter 22. Post-traumatic syringomyelia

Introduction and clinical manifestations

Theories and pathogenesis

Diagnosis

Treatment

Conclusion

References

Chapter 23. Post-traumatic deformity

Introduction

Epidemiology

Patient presentation

Surgical considerations

Outcome

Pediatric deformities

Conclusion

References

Chapter 24. Spinal cord injury clinical trials translational process, review of past and proposed acute trials with reference to recommended trial guidelines

Goals for therapeutic interventions after spinal cord injury

Preclinical discovery and translational process

Spinal cord injury clinical trial process

Past spinal cord injury clinical trials

Lessons learned from previous spinal cord injury trials

Current early phase spinal cord injury trials

General principles for the conduct of valid clinical trials

Concluding remarks

References

Chapter 25. Translating preclinical approaches into human application

Introduction

Regeneration-inducing treatments

Appropriateness of animal spinal cord injury models

Combined damage of peripheral nervous system

Neuronal dysfunction in chronic complete spinal cord injury

What is needed for the future?

References

Chapter 26. Translational spinal cord injury research

Introduction

The translational path

Overview of core translational spinal cord injury research guidelines

Basic preclinical experimental design: guideline considerations

Special design considerations for acute/subacute preclinical spinal cord injury studies

Subacute/chronic injury experimental design issues

Preclinical guidelines and clinical trials past and present

Summary and conclusions

References

Chapter 27. Brain–machine interfaces and transcranial stimulation

Introduction

Cortical brain–machine interfaces

Magnetoencephalography

Transcranial magnetic stimulation

Discussion

References

Chapter 28. Approaches to repairing the damaged spinal cord: overview

Introduction

Targets for repair

Enhancing spontaneous regeneration

Neuroprotection strategies

Gene therapy

Bridges and barriers

Replacing cells

Remyelination

Axonal regeneration

Toward the future

References

Chapter 29. Limiting spinal cord injury by pharmacological intervention

Introduction

Pathophysiology of spinal cord injury

Biochemical changes

Neuroprotective agents

Conclusions

References

Chapter 30. Harmful and beneficial effects of inflammation after spinal cord injury

Introduction

Inflammatory response after spinal cord injury

Harmful and beneficial effects of inflammation

Immunomodulatory drugs for treatment of spinal cord injury

Conclusions

References

Chapter 31. Defeating inhibition of regeneration by scar and myelin components

Introduction

Inhibitory molecules in the central nervous system, and methods to overcome them

Stimulation of long tract axon regeneration

Recovery of function through plasticity

Combinatorial treatments and future prospects

References

Chapter 32. Realizing the maximum potential of Schwann cells to promote recovery from spinal cord injury

Background

Schwann Cells Diminish Cavitation Following Contusion Injury

Schwann Cells Promote Regeneration of Sensory and Propriospinal Axons Following Complete Transection

Schwann Cells Require Additional Interventions to Promote Supraspinal Axon Regeneration and for Axons to Exit the Graft and Re-Enter the Spinal Cord Following Complete Transection

Spinal and Sensory Axons Also Enter Schwann Cell Implants in the Contusion Model

Schwann Cells Require Additional Interventions to Promote Brainstem Axon Growth and for Axons to Exit the Graft and Re-Enter the Spinal Cord Following Contusion Injury

Schwann Cells Myelinate Graft Axons and Remyelinate Denuded Axons

Polysialylated Neural Cell Adhesion Molecule-Engineered Schwann Cells Promote More Repair Than Control Schwann Cells

Schwann Cell Survival Following Implantation Needs Improvement

Olfactory Ensheathing Cells May Aid Schwann Cells in Repairing the Injured Spinal Cord

An Olfactory Ensheathing Cell-Secreted Protein Improves Schwann Cell Function

Immature or Undifferentiated Schwann Cells May be More Effective in Spinal Cord Repair Than Adult-Derived Schwann Cells

Schwann Cells Migrate Into and Within the Glial-Deficient Central Nervous System

Schwann Cells Migrate and Promote Axon Growth in the Minimally Injured Central Nervous System

Autologous Human Schwann Cell Transplantation is Anticipated

Autologous Human Schwann Cells are Currently in Clinical Trial

Summary

References

Chapter 33. Repair of central nervous system lesions by transplantation of olfactory ensheathing cells

Introduction

Properties of olfactory ensheathing cells

Prospects for autologous transplantation of olfactory ensheathing cells as a clinical therapy

References

Chapter 34. Cell transplantation

Introduction

Stem cells for spinal cord injury repair

Stem cells grafts for neuronal replacement

Stem cell grafts to replace oligodendrocytes

Stem cell grafts to enhance axonal regeneration

Stem cell grafts to engender host tissue repair

Conclusions

References

Chapter 35. Gene therapy, neurotrophic factors and spinal cord regeneration

Introduction

Cell and tissue transplantation for axonal regeneration

Ex vivo growth factor gene delivery

Axonal bridging across a spinal cord lesion site

Combinatorial treatments to enhance axonal regeneration

Axonal sprouting, regeneration and functional recovery

Neurotrophic factor gene transfer and axonal regeneration in the chronically injured spinal cord

Conclusions

Acknowledgments

References

Chapter 36. Scaffolds to promote spinal cord regeneration

When are scaffolds necessary and when could they be used?

Types of scaffold used in spinal cord injury models

Biocompatibility of scaffolds and integration with host spinal cord tissue

Strategies to promote sustained axonal regeneration within scaffolds

Axonal guidance, oriented growth and myelination

Exit of axons from scaffolds and the re-establishment of functional connections

Assessment of effectiveness of scaffolds after spinal cord injury

Some requirements for an effective design strategy

References

Chapter 37. Molecular target discovery for neural repair in the functional genomics era

Introduction

Gene expression profiling studies

Future directions

Conclusion

Acknowledgement

References

Chapter 38. Combination therapies

Will combination therapies be necessary to repair the spinal cord?

Single treatments with multiple outcomes

Combinations of treatments

Rehabilitation in combination therapies

Combination therapies: considerations

Summary and conclusions

References

Index