Until now, it has been assumed that after spinal cord injury, patients go through three critical phases: acute, subacute and chronic. It was assumed that during the chronic phase, beginning one year after the spinal cord injury, further functional recovery is impossible. It has also been suggested that the main problem in SCI patients is at the level of the injured spinal cord. Both assumptions have now turned out to be wrong, at least in part.
Misconceptions and misunderstanding of the real pathomechanisms of SCI are the reason for the ineffectiveness of most neurorehabilitation therapies currently in use, which are mainly aimed at stabilizing the patient’s condition rather than restoring his functions. This mainly refers to the subacute and chronic phase.
Unfortunately, treatment, even in the acute phase, does not always take into account the pathophysiology of SCI. In the case of local injury, such as a vertebral fracture that causes mechanical damage, secondary damage caused by edematous swelling of the spinal cord can significantly worsen the outcome. Injury to the spinal cord leads to bleeding and inflammation, causing fluid to build up in the spinal cord (hematoma and edema). This causes the spinal cord to swell. In a confined space such as the spinal canal, the swollen brain cannot expand sufficiently. The swelling then leads to an increase in pressure in the umbilical cord, which compresses the blood vessels and leads to a lack of blood supply, greatly increasing the area of damage. Early aggressive treatment, both surgery and treatment with drugs that reduce edema and control blood pressure, can limit this secondary injury, but is not always used. With unnecessary additional loss of function for the patient.
Both external preclinical and external clinical studies have shown improved recovery in SCI patients when combined with appropriate stem cell therapy.
What therapeutic benefits can be expected after stem cells therapy?
The combination of therapy with stem cell-based neuroregeneration promises good results. External preclinical studies of the action of mesenchymal stem cells and their secretome have shown numerous beneficial effects on damaged spinal cord tissue, such as reorganizing glial scars, improving vascularization, and stimulating axonal growth.
But there are other benefits: patients experienced a reduction in neuropathic pain, positive changes in spasticity, improved sensitivity and, as a result, reduced risk of pressure ulcers. Along with stem cell therapy, epidural stimulation of the damaged area of the spinal cord and neuromuscular system is often used, which provides feedback in the form of the success achieved by patients in restoring mobility in everyday life, that is, getting out of a wheelchair and walking with a walker or crutches.
Epidural stimulation in combination with stem cells treatment:
An advanced procedure to help paralyzed and paralyzed lower and lower extremities regain control of their lives
The procedure involves the surgical implantation of electrodes in the spinal cord, which can then be controlled with using a remote handheld device. The implant works by transmitting nerve signals from the patient’s brain to the tissues of the spinal cord below the level of their damage.
A method of treating chronic pain syndrome, spasticity, dysfunction of the pelvic organs.
The effect is achieved using electrical impulses that are delivered by electrodes implanted in the epidural space.
Electrical impulses activate pain-inhibiting neurons in the posterior horn of the spinal cord, as a result of which the feeling of pain decreases;
Stimulation also causes paresthesia (a feeling of soft pleasant vibration) in the area where the pain originates and its surroundings;
Application considered successful if more than 50% reduction in pain on a visual analogue scale has been achieved;
Every year, more than 15,000 patients worldwide are implanted with neurostimulators to treat chronic neuropathic pain;
Electrodes are connected to a neurostimulator which is implanted subcutaneously.
Stem cells have the ability to bind to immune cells that cause inflammation, and by natural mechanisms not yet understood suppress this immune overreaction. After stopping the inflammatory response in damaged areas, stem cells have the ability to stimulate tissue regeneration. Long-term negative effects like cortisone are not expected. Thus, the goal of stem cell therapy is to quickly relieve pain, suppress inflammation and, at best, even support regeneration. The regenerative effect is most likely to be successful when combined with intensive modern physical therapies such as the epidural stimulation program. This can significantly improve the quality of life, especially for patients with severe pain, as well as the duration and range of motion.