Established and Emerging Therapies in Acute Spinal Cord Injury.

Acute spinal cord injury (SCI) is devastating for patients and their caretakers and has an annual incidence of 20-50 per million people. Following initial assessment with appropriate physical examination and imaging, patients who are deemed surgical candidates should undergo decompression with stabilization. Earlier intervention can improve neurological recovery in the post-operative period while allowing earlier mobilization. Optimized medical management is paramount to improve outcomes. Emerging strategies for managing SCI in the acute period stem from an evolving understanding of the pathophysiology of the injury. General areas of focus include ischemia prevention, reduction of secondary injury due to inflammation, modulation of the cytotoxic and immune response, and promotion of cellular regeneration. In this article, we review established, emerging, and novel experimental therapies. Continued translational research on these methods will improve the feasibility of bench-to-bedside innovations in treating patients with acute SCI.

Interobserver Reliability of Magnetic Resonance Imaging Predictors of Outcome in Cervical Spine Degenerative Conditions.

BACKGROUND: Although recent work has focused on characterizing quantitative magnetic resonance imaging (MRI) markers that may predict outcome among patients with cervical degenerative conditions, little is known about their reliability. Measurement and reporting of these markers is time-consuming and nonstandardized, preventing routine use in clinical care. METHODS: We retrospectively analyzed cervical MRI among subjects prospectively enrolled in a health outcomes study of elective surgery for degenerative cervical spine conditions. Two radiologists independently reviewed MRI for presence or absence and length of cord signal change, level of worst cord compression, axial anteroposterior (AP) and lateral spinal cord diameter, midsagittal AP diameter, and kyphosis. Interobserver reliability was compared using kappa and intraclass correlation coefficient (ICC). RESULTS: Inclusion criteria were met by 209 patients who had MRI available for review. Most patients were female (58%) and middle-aged (mean age 51 years), and 54% had a diagnosis of myelopathy. Reliability was fair for cord signal change on T1 (κ = 0.33) and good on T2 (κ = 0.74) images. Among patients with T2 change (n = 22), reliability for signal change length was good (ICC = 0.67). For level of worst compression, reliability was good (κ = 0.79). For AP cord diameter, reliability was very good (ICC = 0.82; T2/midsagittal) and good (ICC = 0.66; T2/axial). Reliability was moderate for lateral cord diameter (ICC = 0.55; T2/axial) and good for kyphosis (κ = 0.76). CONCLUSIONS: Good and very good reliability observed in measuring T2-weighted spinal cord signal change, level of worst compression, AP cord diameter, and kyphosis support use of these markers in standardized reporting, which could be incorporated into routine clinical use.

Fate of stem cell transplants in peripheral nerves.

While damaged peripheral nerves demonstrate some potential to regenerate, complete functional recovery remains infrequent, owing to a functional loss of supportive Schwann cells distal to the injury. An emerging solution to improve upon this intrinsic regenerative capacity is to supplement injured nerves with stem cells derived from various tissues. While many of these strategies have proven successful in animal models, few studies have examined the behavior of transplanted stem cells in vivo, including whether they survive and differentiate. In previous work, we demonstrated that cells derived from neonatal rodent dermis (skin-derived precursor cells, or SKPs) could improve regenerative parameters when transplanted distal to both acute and chronic nerve injuries in Lewis rats. The aim of this work was to track the fate of these cells in various nerve injury paradigms and determine the response of these cells to a known glial growth factor. Here, we report that SKPs survive, respond to local cues, differentiate into myelinating Schwann cells, and avoid complete clearance by the host's immune defenses for a minimum of 10weeks. Moreover, the ultimate fate of SKPs in vivo depends on the nerve environment into which they are injected and can be modified by inclusion of heregulin-1ß.