Customarily, there are two stages of Spinal Cord Injury i.e. Primary Stage and Secondary Stage
The primary injury illustrates the initial physical trauma to the spine which may occur through severe fall, car accident, and any other such kind of traumatic incident.
Initially, primary injury is the result of neurological injury or spinal cord injury, possibly occur from:
I.Physical compression of the spinal cord/nerves: Due to injury, the bone, disc, and or ligament compressed the tissues and narrow down the spinal canal or sometimes also change its alignment. Consequently, nerves squeezed.
II.Stretch of the tissues: The spinal cord could be pathetically injured even in the condition of the least trauma attributed to it directly.
III.Blood supply mutilation: Due to injury, the inner capillary network or microscopic blood vessels could be smashed immediately. Resultantly cause instant hemorrhage or bleeding into the cord.
However, the injury of the spinal cord can be diagnosed on an MRI just after trauma.
The secondary injury is the cascade effects of the incidents in the body following the primary trauma. Nevertheless, for the occurrence of secondary injury, there is no fixed time, it could occur after seconds, hours, days, and even weeks. Abreast, there are numerous factors that determine the severity of the secondary injury. In the condition of secondary injury, body releases flow of chemicals in response to the trauma. Subsequently, these chemicals cause inflammation, reduce spinal cord blood flow, and ultimately cells die.
Treatment of the spinal cord injury is normally aimed at steps involved in the series of injury with the following distinctive objectives:
a.lessening inflammation
b.reducing degradation and cell death
c.escalating blood flow
d.diminishing scar formation
Primarily, the motto of treatment of the spinal cord injury is to concentrate on alleviating the injury. Afterwards, when it accomplished to its fullest, then the two other objectives of treatment focused viz ….
i.transplanting nerves
ii.nerve rejuvenation
Treatments of Spinal Cord Injury: an Analytical Overview
The purpose of spinal cord treatment is to lessen the effects of primary and secondary damage. The first step of treatment is to control the spine in order to avoid any further injury. But this sort of treatment can be done on the spot of the accident itself with the help of hard collar or brace.
However, there are some supplementary treatments such as IV fluids and mediations to maintain blood pressure and administer the oxygen. The techniques used for the treatments of the primary injury are standard and hence very fruitful.
Surgery is one of the most effective ways of treatment; advantage of this treatment is – it controls the situation very fast by eliminating physical impingement on the nerves. Resultantly, it not only reinstates blood flow but also provides space for successive inflammation.
In order to repair alignment of the bone and correct bony deformity, surgery has been done sometimes later. It can be significant for the decompression (i.e. removing the pressure off the nerves) in taking full advantage of the patient’s rehabilitation. Moreover, the surgery stabilizes the patients and assists in sitting, standing, walking, and also balances their weights on their trunks.
The drug treatment of primary injury of spinal cord injury is very limited and hence the only drug advised by the medical community for the immediately use of primary injury is Methylprednisolone. However, as per study of 1990, a multi-center examination of methylprednisolone illustrated that the steroid enhanced the neurological function in a subset of patients who were provided the drug within the first eight hours of injury. Thereupon, there are many physicians apply this treatment.
In spite of this, there is ambiguity of this research and debate is still going on within the medical community concerning the usefulness of methylprednisolone. And, till date, it has not been proved as a standard of treatment by any important medical associations especially by the American Association of Neurological Surgeons which suppose to be one of the best associations for the Neurological research and treatment.
Methods of Research for the Spinal Cord Injury Treatments
Generally, all sorts of experiments and treatments have been done successfully over animals. This is procedures that before giving any treatment to human being first give to animals. Nevertheless, most of the times, the advantage of this experiment in human beings has been proven unproductive. Actually, after hundred of various treatments which were in fact successful over the animals, only methylprednisolone has been verified reasonably consistent findings for human beings.
However, there are following reasons which are explaining why research for spinal cord injuries is difficult:
I.Anatomical differences in rodent spinal cords: Normally, rodents are classically used for most of the animal researches; and, the problem is – the construction of the spinal cord which has intrinsic pathways and can generate stepping patterns in the legs and there is no signal from the brain. This the reason that an animal can learn to walk again even after stern spinal cord injury without any treatment. But human spinal cords have not this kind of facility.
II.Difference between an actual injury and a simulated one: Almost in all clinical cases of spinal cord injury results in important trauma to the bony spine and repeatedly has neurological compression much bigger than that appeared in the majority of animal models throughout the simulated injury. Hence, treatments may be successful in animal trials where there are fewer traumas to the bones and lesser nerve injury. And, when the same treatments are experimented for the real injuries, they might be less effective because the reason is the severeness of the injury.
Secondly, while experimenting spinal cord treatments, researchers generally take consideration of moderate spinal cord injuries whereas in human cases the injuries are whether too severe to treat or very moderate that recuperation occurs without any treatment.
III.Complexities in exercising the same experiments and research on animals and humans: when researchers experiment on the spinal cord injured person, there are various factors (that cannot be controlled) playing their roles simultaneously. Subsequently, all different sorts of injuries are required to treat differently. And, this is big problem which cannot be seen in animal research.
E.g. in the case of animals, the treatment can be initiated in the laboratory generally after an hour of injury which is not practicable in many clinical settings for human beings. Above all, animal injuries are very limited and not much deeper, but in the human cases, the injuries are very complex. Therefore, only one method of treatment cannot be successful.
Hopeful Treatments
Some of the important medicines like hypothermia, naloxone, and corticosteroids have revealed excellent results in animal experiments. Hence, these are most hopeful treatments of spinal cord injury, but there are contradictory results in human experiments. In spite of suffice positive results of various researches, researchers and physicians remain far behind from innovating an accurately and efficient treatment for the spinal cord injured person.
However, hypothermia experiment has drawn a lot of attention because of one of the publicized cases of its use. Actually in 2007, hypothermia is used with Kevin Everett, a tight end with the Buffalo Bills, who endured a spinal cord injury. This is again regrettable that in spite of ostensible success in above given case, the applicability of hypothermia for the human being treatment has failed to usher any advantageous result. Not only this, it also generated some risks i.e. overshadow the benefits. Subsequently, in one of the experiments, the researchers from The Miami Project to Cure Paralysis advised that the cooling “may diminish blood flow in the injured spinal cord and further aggravate secondary injury”.
Conclusion
Till date, research for the treatment of spinal cord injury remains the most important focal point for the medical community. There have been a few incremental improvements; but we have not yet seen the important breakthrough that we all are expecting. However, with persistent experiments, treatments for spinal cord injuries will suppose to improve in coming future.