Cell Therapy as a Tool for Emergency Care in Spinal Cord Injuries

Spinal cord injuries are devastating events that can lead to significant disability. In the immediate aftermath of such an injury, the primary focus of healthcare professionals is to prevent further damage and stabilize the patient. While current emergency treatments are crucial, the emerging field of cell therapy holds promise as a revolutionary tool to enhance emergency care and improve outcomes for spinal cord injury patients.

Diagnosing Spinal Cord Injuries in the Emergency Setting

In the emergency room, prompt and accurate diagnosis of a spinal cord injury is paramount. Healthcare professionals conduct a thorough physical exam, assessing sensory function and movement, alongside gathering information about the accident. This initial evaluation can sometimes rule out a spinal cord injury.

However, if the patient presents with neck pain, altered consciousness, or neurological deficits like weakness, immediate diagnostic testing becomes necessary. These tests are critical for confirming the injury and determining its extent:

X-rays: These are often the first imaging tests performed, capable of revealing fractures, dislocations, or tumors affecting the vertebrae, the bony structures surrounding the spinal cord.
CT Scans: Computed tomography (CT) scans offer more detailed images than X-rays. By combining X-rays with computer processing, CT scans produce cross-sectional views, allowing for better visualization of bone injuries, disc herniation, and other spinal abnormalities.
MRI Scans: Magnetic resonance imaging (MRI) is invaluable for assessing soft tissues, including the spinal cord itself. MRI utilizes strong magnetic fields and radio waves to generate detailed images, making it highly effective in detecting spinal cord compression from herniated discs, blood clots, or other masses.

A comprehensive neurological examination, often performed a few days post-injury once swelling subsides, determines the injury’s level and completeness. This examination rigorously tests muscle strength and sensory perception to light touch and pinprick, providing a detailed neurological profile.

Current Emergency Treatments for Spinal Cord Injury

Currently, there is no cure to reverse spinal cord damage. Treatment strategies are centered on preventing secondary injury, minimizing complications, and maximizing the patient’s functional recovery and quality of life. Emergency actions taken at the accident scene and in the initial hours after injury are crucial in determining long-term outcomes.

Immediate Actions at the Scene

Emergency medical personnel are trained to prioritize spinal immobilization at the accident site. This involves gently and swiftly securing the spine using a rigid neck collar and a rigid carrying board to prevent any further movement that could exacerbate the injury during transport to the hospital.

Hospital Emergency Room Care

Upon arrival at the emergency room, the focus shifts to several critical interventions:

Maintaining Respiratory Function: Spinal cord injuries, particularly those high in the cervical spine, can impair breathing. Ensuring adequate airway and ventilation is the top priority, potentially requiring mechanical ventilation.
Preventing Shock: Spinal shock, a temporary loss of spinal cord function below the injury level, can lead to dangerous drops in blood pressure. Fluid resuscitation and medications may be needed to stabilize blood pressure and prevent shock.
Immobilizing the Neck: Continued spinal immobilization is essential to prevent further damage. This may involve traction to gently realign the spine.
Avoiding Complications: Early complications such as urinary and bowel retention, respiratory and cardiovascular issues, and deep vein thrombosis are proactively managed.

Patients with spinal cord injuries are typically admitted to the intensive care unit (ICU) or specialized spinal injury centers. These centers offer multidisciplinary care teams including neurosurgeons, orthopedic surgeons, neurologists, rehabilitation specialists, psychologists, nurses, and therapists, all specializing in spinal cord injury management.

Limitations of Current Emergency Treatments

While current emergency treatments are vital for stabilization and preventing secondary damage, they do not address the primary injury to the spinal cord itself. This is where cell therapy emerges as a promising frontier.

Cell Therapy: A New Horizon in Emergency Spinal Cord Injury Care

Cell therapy, also known as regenerative medicine, offers innovative approaches to repair or replace damaged tissues in the spinal cord. In the context of emergency care for spinal cord injuries, cell therapy aims to:

Reduce Cell Death: Spinal cord injury triggers a cascade of secondary injury mechanisms, including inflammation and cell death (apoptosis). Cell therapies can deliver neuroprotective agents directly to the injury site to mitigate these processes and preserve viable neural tissue.
Promote Nerve Regeneration: A major obstacle in spinal cord injury recovery is the limited capacity of nerve cells (neurons) to regenerate. Cell therapies, particularly stem cell transplantation, hold the potential to stimulate nerve regeneration and bridge the injury gap.
Modulate Inflammation: While inflammation is a natural response to injury, excessive inflammation in the spinal cord can be detrimental. Certain cell types, such as mesenchymal stem cells, possess immunomodulatory properties that can help regulate inflammation and create a more conducive environment for healing.
Enhance Neuroplasticity: Neuroplasticity, the brain and spinal cord’s ability to reorganize and form new connections, is crucial for functional recovery. Cell therapies can release growth factors and other molecules that promote neuroplasticity and help spared neural circuits compensate for the injury.

Types of Cell Therapies Being Explored

Several types of cell therapies are under investigation for spinal cord injury, with potential applications in the emergency setting:

Neural Stem Cells (NSCs): These cells can differentiate into various neural cell types, including neurons and glial cells. Transplanted NSCs may replace damaged cells, promote regeneration, and provide trophic support to surviving neurons.
Mesenchymal Stem Cells (MSCs): MSCs are multipotent stromal cells that can be sourced from bone marrow, adipose tissue, and other sources. MSCs are known for their immunomodulatory and neuroprotective properties. They can secrete factors that reduce inflammation, protect neurons from damage, and promote blood vessel formation, which is vital for tissue repair.
Induced Pluripotent Stem Cells (iPSCs): iPSCs are generated by reprogramming adult cells back to a pluripotent state similar to embryonic stem cells. This technology offers a virtually unlimited source of patient-specific cells, reducing the risk of immune rejection. iPSCs can be differentiated into NSCs and other neural cell types for transplantation.
Oligodendrocyte Progenitor Cells (OPCs): Oligodendrocytes are cells that produce myelin, the insulating sheath around nerve fibers that is often damaged in spinal cord injury. Transplanting OPCs aims to promote remyelination, improving nerve signal transmission.

Experimental and Future Directions

Cell therapy for spinal cord injury is still largely experimental, but pre-clinical and clinical studies are showing promising results. Researchers are actively investigating:

Timing of Cell Therapy Administration: Determining the optimal time window for cell therapy administration after spinal cord injury is critical. Emergency care settings offer a unique opportunity for early intervention, potentially maximizing the benefits of cell therapy.
Delivery Methods: Various delivery methods are being explored, including direct injection into the injury site, intravenous infusion, and minimally invasive techniques.
Combination Therapies: Combining cell therapy with other treatments, such as rehabilitation, pharmacological agents, or biomaterials, may enhance therapeutic efficacy.
Clinical Trials: Numerous clinical trials are underway to evaluate the safety and efficacy of different cell therapy approaches for spinal cord injury. These trials are crucial for translating pre-clinical findings into clinically available treatments.

Ongoing Care and Rehabilitation

Regardless of whether cell therapy becomes a standard emergency treatment in the future, ongoing care and rehabilitation remain essential components of spinal cord injury management. As the patient stabilizes medically, the focus expands to preventing secondary medical conditions and promoting functional recovery.

Rehabilitation Programs

Comprehensive rehabilitation programs are initiated early, involving a multidisciplinary team of physical therapists, occupational therapists, rehabilitation nurses, psychologists, and social workers. Rehabilitation focuses on:

Maintaining and Strengthening Muscle Function: Physical therapy aims to prevent muscle atrophy and contractures, improve strength and range of motion, and facilitate motor recovery.
Redeveloping Fine Motor Skills: Occupational therapy focuses on regaining fine motor skills necessary for daily living activities, such as dressing, eating, and grooming.
Adaptive Strategies and Assistive Devices: Rehabilitation teaches patients adaptive techniques and how to use assistive devices, like wheelchairs, braces, and computer adaptations, to enhance independence and participation in daily life.
Psychological and Social Support: Coping with a spinal cord injury is a significant life adjustment. Psychological support, counseling, and peer support groups are vital to address emotional challenges, promote mental well-being, and facilitate social reintegration.

Medications and New Technologies

Medications play a crucial role in managing secondary complications of spinal cord injury, such as pain, spasticity, bladder and bowel dysfunction, and sexual dysfunction.

Advancements in technology continue to improve the lives of individuals with spinal cord injuries. Modern wheelchairs, computer adaptations, electronic aids for daily living, and functional electrical stimulation devices all contribute to greater independence and mobility.

Prognosis and Hope for the Future

The prognosis after a spinal cord injury is variable and depends on the severity and level of the injury. While significant recovery can occur, especially in the first six months, some individuals experience ongoing functional limitations.

However, ongoing research, particularly in cell therapy and regenerative medicine, offers hope for improved treatments and greater recovery potential in the future. Clinical trials and scientific advancements are continuously pushing the boundaries of what is possible in spinal cord injury care.

Coping and Support

Adjusting to life after a spinal cord injury is a significant emotional and practical challenge. Grief, emotional distress, and concerns about lifestyle changes are common. Accessing psychological support, joining support groups, and connecting with peer mentors can be incredibly helpful.

Taking control by educating oneself about the injury, exploring available resources, and actively participating in rehabilitation are empowering steps. Open communication with loved ones, healthcare professionals, and support networks is crucial for navigating the journey of recovery and adaptation.

Preparing for Emergency Care

Traumatic spinal cord injuries are medical emergencies requiring immediate attention. Being prepared to provide information about the accident, having a family member or friend present for medical discussions, and writing down questions for the healthcare team can facilitate effective communication and care in the emergency setting.

While cell therapy is not yet a standard emergency treatment for spinal cord injuries, it represents a rapidly evolving and highly promising field. As research progresses, cell-based therapies may well become integral tools in the emergency care arsenal, offering new hope for improved outcomes and enhanced recovery for individuals affected by these devastating injuries.

References

Spinal cord injury: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Spinal-Cord-Injury-Hope-Through-Research. Accessed July 10, 2021.
Hansebout RR, et al. Acute traumatic spinal cord injury. https://www.uptodate.com/contents/search. Accessed July 10, 2021.
Spinal cord injury. American Association of Neurological Surgeons. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury. Accessed July 10, 2021.
Jankovic J, et al., eds. Spinal cord trauma. In: Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed July 20, 2021.
AskMayoExpert. Spinal cord injury. Mayo Clinic; 2021.
Abrams GM, et al. Chronic complications of spinal cord injury and disease. https://www.uptodate.com/contents/search. Accessed July 31, 2023.
Shibata T, et al. A review of treatment methods focusing on human induced pluripotent stem cell-derived neural stem/progenitor cell transplantation for chronic spinal cord injury. Medicina. 2023; doi:10.3390/medicina59071235.
Spinal trauma. Merck Manual Professional Version. http://www.merckmanuals.com/professional/injuries-poisoning/spinal-trauma/spinal-trauma. Accessed June 10, 2021.
Wang R, et al. Pharmacological interventions targeting the microcirculation following traumatic spinal cord injury. Neural Regeneration Research. 2024; doi:10.4103/1673-5374.375304.
Devlin VJ, ed. Spinal cord injury. In: Spine Secrets. 3rd ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed July 25, 2023.
Nimmagadda R. Allscripts EPSi. Mayo Clinic. July 26, 2024.
Ropper AH, et al. Diseases of the spinal cord. In: Adams and Victor’s Principles of Neurology. 12th ed. McGraw Hill; 2023. https://accessmedicine.mhmedical.com. Accessed July 31, 2023.
Neck or back injury. American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/neck-or-back-injury. Accessed July 31, 2023.
Eisen A. Anatomy and localization of spinal cord disorders. https://www.uptodate.com/contents/search. Accessed Aug. 1, 2023.
Keep child passengers safe on the road. Centers for Disease Control and Prevention. https://www.cdc.gov/injury/features/child-passenger-safety/. Accessed Aug. 3, 2023.
Montoto-Meijide R, et al. Mesenchymal stem cell therapy in traumatic spinal cord injury: A systematic review. International Journal of Molecular Sciences. 2023; doi:10.3390/ijms241411719.
Huang XL, et al. Potential benefits of spinal cord stimulation treatment on quality of life for paralyzed patients with spinal cord injury. Tzu Chi Medical Journal. 2022; doi:10.4103/tcmj.tcmj_102_22.
Provider profile. CARF International. https://www.carf.org/providerProfile.aspx?cid=8020. Accessed Aug. 3, 2023.
Eapen BD, et al, eds. Participation/living with spinal cord injury. In: Spinal Cord Injury. Elsevier; 2023. https://www.clinicalkey.com. Accessed Aug. 4, 2023.
Laskowski ER (expert opinion). Mayo Clinic. Aug. 9, 2023.
Swimming safely in lakes, rivers and streams. American Red Cross. https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/water-safety/lake-river-safety.html. Accessed Aug. 10, 2023.
Houlihan N, et al. Pediatric diving-related injuries in swimming pools presenting to US emergency departments: 2008-2020. Pediatric Emergency Care. 2023; doi:10.1097/PEC.0000000000003007.
Adjusting to life after spinal cord injury. Model Systems Knowledge Translation Center. https://msktc.org/sci/factsheets/adjusting-life-after-spinal-cord-injury. Accessed Aug. 10, 2023.
Rocchi MA, et al. Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: A qualitative meta-synthesis. Psychology & Health. 2022; doi:10.1080/08870446.2021.1890729.
McLeod J, et al. Community peer support among individuals living with spinal cord injury. Journal of Health Psychology. 2023; doi:10.1177/13591053231159483.
Jones K, et al. Spirituality, hope, and resilience in the recovery and adaptation process following spinal cord injury. Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury. 2022; doi:10.1016/B978-1-12-822427-4.00038-1.