The Basis for Restoring Function Following Spinal Cord Injury

The Basis for Restoring Function Following Spinal Cord Injury

TAKE-HOME MESSAGE

  • Neurologists who are interested in the restoration of function of patients suffering spinal cord injuries must fully understand the normal function of the spinal cord and identify the specific structures that are injured
  • There are very different problems that a patient will face following spinal cord injury and they are based on the exact structures that are damaged and the impaired physiology.
  • This review points to the different types of spinal cord injury and lays a foundation for how the patient can be rehabilitated following injury.
  • This is a must read for clinicians interested in spinal cord function and rehabilitation.

Abstract

An appreciation of the neuropathology of human spinal cord injury (SCI) is a basic requirement for all concerned with the medical treatment of patients with SCI as well as for the many neuroscientists devoted to finding a “cure”. An understanding of the neuropathology of SCI is a necessary guide to those concerned at all levels of treatment, whether they are doctors or other health professionals. The underlying changes in the spinal cord are especially relevant to the restorative neurology (RN) of SCI. The new discipline of RN seeks to enhance the function of residual spinal cord elements which have survived the injury and so improve the patient’s rehabilitative status. This is in contrast to the conventional approach in rehabilitation which works around the clinical neurological deficiencies. Following the injury a series of changes take place in the spinal cord and surrounding tissues which continue to evolve throughout the life of the patient. In flexion and extension injuries resulting from motor vehicle trauma, diving and sporting accidents the spinal cord is compressed and disrupted but usually with some continuity remaining in the white matter columns. The brunt of the injury is usually centrally placed where there is bleeding Spinal Cord 2into the disrupted grey matter involving one or two segments, usually cervical. The loss of central grey matter is nowhere near as important as is the tearing apart of the white matter tracts in determining the patient’s clinical state. The central grey matter supplies one two overlapping segmental myotomes and sensory fields. In contrast loss of continuity in the long white matter tracts is catastrophic because all functions below the level of injury are affected, autonomic or voluntary either by paralysis or anaesthesia, usually both. It is important to determine the exact nature of the injury in every patient as a preliminary to treatment by RN. This assessment is both clinical and neurophysiological with special attention given to any part of the long white matter tracts which may have escaped the initial injury. It is these residual nerve fibres which provide the opportunity to improve the patient’s neurological state by being re-activated, modulated and enhanced by stimulation or by other RN methods. The conversion of a clinically complete SCI patient to being incomplete and ambulant is a tremendous improvement in the patient’s status. It is the purpose of this article to provide the reader with the essential neuropathology of SCI as a beginning point in planning treatment whether it is medical or ancillary, as well as to inform the neuroscientist about the condition being addressed in his or her research.

Citation

Kakulas BA1, Kaelan C2. The neuropathological foundations for the restorative neurology of spinal cord injury. Clin Neurol Neurosurg. 2015 Feb;129 Suppl 1:S1-7. doi: 10.1016/j.clineuro.2015.01.012. Epub 2015 Jan 29.

  1. Western Australian Neuroscience Institute. Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Australia. Electronic address: kakulas@wanri.uwa.edu.au.
  2. Faculty of Medicine, Hasanuddin University, Indonesia.
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