Clinical Neurorestorative Therapeutic Guidelines for Spinal Cord Injury (IANR/CANR version 2019).

Functional restoration after spinal cord injury (SCI) is one of the most challenging tasks in neurological clinical practice. With a view to exploring effective neurorestorative methods in the acute, subacute, and chronic phases of SCI, "Clinical Therapeutic Guidelines of Neurorestoration for Spinal Cord Injury (China Version 2016)" was first â€‹proposed in 2016 by the Chinese Association of Neurorestoratology (CANR). Given the rapid advances in this field in recent years, the International Association of Neurorestoratology (IANR) and CANR formed and approved the "Clinical Neurorestorative Therapeutic Guidelines for Spinal Cord Injury (IANR/CANR version 2019)". These guidelines mainly introduce restoring damaged neurological structure and functions by varying neurorestorative strategies in acute, subacute, and chronic phases of SCI. These guidelines can provide a neurorestorative therapeutic standard or reference for clinicians and researchers in clinical practice to maximally restore functions of patients with SCI and improve their quality of life. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This guideline provided comprehensive management strategies for SCI, which contains the evaluation and diagnosis, pre-hospital first aid, treatments, rehabilitation training, and complications management. Nowadays, amounts of neurorestorative strategies have been demonstrated to be benefit in promoting the functional recovery and improving the quality of life for SCI patients by clinical trials. Also, the positive results of preclinical research provided lots of new neurorestorative strategies for SCI treatment. These promising neurorestorative strategies are worthy of translation in the future and can promote the advancement of SCI treatments.

Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case.

STUDY DESIGN: Case report. OBJECTIVES: To report an unusual case of spontaneous spinal subdural hematoma and to review relevant literature and discuss the etiology, pathogenesis, clinical features, imaging, and prognosis. SUMMARY OF BACKGROUND DATA: Spontaneous spinal subdural hematoma with no underline pathology is a very rare condition. Only 19 cases have been previously reported. METHODS: The case of a 44-year-old man is presented. Pubmed (Medline) was used to search publications. RESULTS: Our patient presented with sudden severe low back pain following a minimal effort, with rapid onset of complete paraplegia. MRI revealed an anterior subdural hematoma from T2-T6 with cord compression. An urgent laminectomy was performed. MRI scan, surgery, and CT angiogram did not reveal any underlying pathology to account for the subdural hematoma. The patient demonstrated substantial clinical improvement after 6 weeks of bed rest and intense rehabilitation program. CONCLUSION: Spinal subdural hematoma (SSDH) is uncommon and can be caused by abnormalities of coagulation, blood dyscrasias, or trauma, underlying neoplasm, and arteriovenous malformation. SSDH is very rare in the absence of these underlying conditions. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, varying degrees of motor, sensory, and autonomic disturbances. On MRI, SSDH is seen as a space-occupying lesion, usually ventrally, contained within the dura matter, and can demonstrate variable T1 and T2 signal depending on the age of the hematoma. The prognosis is variable. The majority of cases in the literature had surgical decompression, although cases that were managed conservatively have been reported to be successful as well. The indications of surgery need to be clarified.

Olfactory ensheathing cells: ripples of an incoming tide?

Until now, brain and spinal cord injuries that sever nerve fibres have resulted in a degree of incurable functional loss. An incoming tide of research is now beginning to challenge this as yet unbreached sea wall. One of the most promising approaches involves a recently discovered type of cell, the olfactory ensheathing cell, which can be obtained from the adult nasal lining. In animal models transplantation of cultured olfactory ensheathing cells into an injured spinal cord induces regeneration, remyelination of severed spinal nerve fibres, and functional recovery. Although several clinical centres worldwide have shown an interest in applying this approach to patients with spinal cord injury, there is no agreement on cell technology, and claims of beneficial results lack independent confirmation. Important aspects still need to be worked out at the laboratory level. Overall, the outlook is optimistic, but there is still some way to go.