Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature

Objective: Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment moda...

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Main Authors: Akbary Kutbuddin, Arora Shobha S
Format: Article
Language:English
Published: Elsevier 2014-06-01
Series:Chinese Journal of Traumatology
Online Access:http://www.cjtrauma.com/apps/ojs/index.php/cjt/article/view/528
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spelling doaj-357d834cf9c74b53858d08cd82a1339b2020-11-25T00:53:54ZengElsevierChinese Journal of Traumatology1008-12752014-06-01173157164316Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literatureAkbary KutbuddinArora Shobha SObjective: Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment modalities have been used. The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success. Thus, more clinical studies are required to study the effect of this novel approach Methods: This is a prospective hospital-based cohort study (level IV). The study was conducted in the Dept. of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi from November 2010 to March 2012. Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study. Under suitable anaesthesia, at the beginning of surgery, 100 ml of bone marrow was aspirated. This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs. After surgical decompression and stabilization, the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle. All the patients were evaluated for neurological improvement using the American Spinal Injury Association (ASIA) score and Frankel grade at 6 weeks and 3 months postoperatively. Results: The evaluation at 6 weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade. The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades. The current pilot study has shown that there has been no improvement in most of the recipients of the transplant (n=8). Some patients (n=2) who did show some improvement in their sensory scores proved to be of no signifi cant functional value as depicted by no change in their Frankel Grades. Conclusion: The outcome of current study shows that although this modality of treatment is safe for the patients, it provides no additional benefits on improvement of quality of life among these patients. Key words: Spinal cord injuries; Stem cells; Spinal cord regeneration; Bone marrow transplantationhttp://www.cjtrauma.com/apps/ojs/index.php/cjt/article/view/528
collection DOAJ
language English
format Article
sources DOAJ
author Akbary Kutbuddin
Arora Shobha S
spellingShingle Akbary Kutbuddin
Arora Shobha S
Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
Chinese Journal of Traumatology
author_facet Akbary Kutbuddin
Arora Shobha S
author_sort Akbary Kutbuddin
title Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
title_short Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
title_full Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
title_fullStr Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
title_full_unstemmed Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
title_sort biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature
publisher Elsevier
series Chinese Journal of Traumatology
issn 1008-1275
publishDate 2014-06-01
description Objective: Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment modalities have been used. The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success. Thus, more clinical studies are required to study the effect of this novel approach Methods: This is a prospective hospital-based cohort study (level IV). The study was conducted in the Dept. of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi from November 2010 to March 2012. Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study. Under suitable anaesthesia, at the beginning of surgery, 100 ml of bone marrow was aspirated. This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs. After surgical decompression and stabilization, the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle. All the patients were evaluated for neurological improvement using the American Spinal Injury Association (ASIA) score and Frankel grade at 6 weeks and 3 months postoperatively. Results: The evaluation at 6 weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade. The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades. The current pilot study has shown that there has been no improvement in most of the recipients of the transplant (n=8). Some patients (n=2) who did show some improvement in their sensory scores proved to be of no signifi cant functional value as depicted by no change in their Frankel Grades. Conclusion: The outcome of current study shows that although this modality of treatment is safe for the patients, it provides no additional benefits on improvement of quality of life among these patients. Key words: Spinal cord injuries; Stem cells; Spinal cord regeneration; Bone marrow transplantation
url http://www.cjtrauma.com/apps/ojs/index.php/cjt/article/view/528
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