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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #211
    Quote Originally Posted by Wise Young
    A disk herniation is a compression injury of the spinal cord. In my opinion, the spinal cord should be decompressed. There is probably no other part of the body or central nervous system where we would allow compression to continue as it has been for the spinal cord. For example, if something is pressing on the eyeball, a peripheral nerve, the heart, or any organ, the first thing that the doctor does is to decompress.

    Decompression surgery is not very risky. Of course, appropriate care should be taken to ensure that the spinal column is stable and the spinal cord is minimally disturbed during the decompression. And yes, there is some risk, as there is always with any surgery. However, the risk of leaving something compressed is far greater than doing surgery to decompress.

    If you have something that is compressing your spinal cord and it is causing neurological deficit, it should be removed. I have written several articles summarizing the literature on this subject. One of them is linked in a post below.

    If you have something that is compressing your spinal root and it is causing neurological deficit, it should be removed as soon as possible. There is some data suggesting that leaving the spinal root compressed for more than 3 months will significantly reduce the probability of recovery associated with decompression.

    The first criterion is of course the presence of cord compression. It there is no compression, there is no decompression. The question is what is compression. Some people say 10% of the diameter of the cord while others say 25%. The second criterion is presence of neurological deficits. If there is no neurological deficit, then you can afford to wait. However, if there is neurological deficit and you have cord compression, it should be operated relatively soon. Many neurosurgeons and orthopedic surgeon, however, will not decompress just because of pain alone. This is because decompressive surgery often will not eliminate pain. Third, while pain alone is not sufficient to warrant surgery, it should b considered if it is combined with neurological deficits (such as motor and sensory loss).

    If you are incomplete, that is good news because decompression helps people with their neurological deficits much than that it would help somebody with a sefere injury.

    Wise.
    Dear Dr Young,
    Thank you for this info, which already clarifies a lot.
    You mention a post with a link ?
    By the way, just for the sake of clarity, this concerns a friend of mine who has a hernia. This info above, though, is also interesting to me, since my own spinal cord remained compressed for 4 months [the time for me to arrange a second opinion and to convince doctors to go for a second [decompression] surgery ! ].
    Kind regards. Corinne

  2. #212

    cure?

    " preparing for the cure"? Am I missing something here? The list Dr. Young just gave me shows no remote signal of a cure. Why hasn't Korea started with their spinal injured patients to therapuetic clone? In reality, they already accomplished the hard part, disproving the truckload of naysayers. After long term SCI doesn't all the tissue become necrotic, rotted, and narrowed? How in the hell can this lifeless tissue become re-activated into the super computer it once was, restoring electricity from the injury level down. This electricity hasn't been successfully restored up to now, and what ever happened to embryonic stem cells internationally?

  3. #213
    Quote Originally Posted by damagedgoods
    " preparing for the cure"? Am I missing something here? The list Dr. Young just gave me shows no remote signal of a cure. Why hasn't Korea started with their spinal injured patients to therapuetic clone? In reality, they already accomplished the hard part, disproving the truckload of naysayers. After long term SCI doesn't all the tissue become necrotic, rotted, and narrowed? How in the hell can this lifeless tissue become re-activated into the super computer it once was, restoring electricity from the injury level down. This electricity hasn't been successfully restored up to now, and what ever happened to embryonic stem cells internationally?
    Your spinal cord is not lifeless. What level is your injury and do you have spasticity?

    Wise.

  4. #214
    Quote Originally Posted by Cherrylips
    Dr Young,

    Was wondering if you could comment - I read somewhere that a Cervical injury will be enevitably easier to 'cure' / 'regenerate' than that of the same lesion but at T, L OR S level. Is this simply because of the smaller surface area, for example

    thanks in advance

    Dr young i wonder if you noticed my last post and could comment

    thanks

  5. #215

    cervical sci for cure

    The top part of the cervical spinal cord is actually enlarged if I'm not mistaken, similar to the lumbar spinal cord. Pretty much the bottom and the top are the thick parts of the cord, since I assume they access and store information to be sent through the rest of the spinal cord.
    As cure is concerned, I don't think any part of the spinal cord is easier to cure than the other, and a cure, 100% cure, is most likely at least 40+ years away. What we can only hope for are tiny little improvements with quality of life issues in the next several decades. Hey, it's great to be optimistic, but I don't see where everyone is getting this cure idea from.

  6. #216
    Quote Originally Posted by Cherrylips
    Dr young i wonder if you noticed my last post and could comment

    thanks
    Cherrylips,

    While what you say does seem to be true, i.e. there are more severe or "complete" injuries in the thoracic and lumbar cord, I don't think that the problem is in the thickness of the spinal cord but rather the forces that are necessary to injure the spinal cord. The neck is the most vulnerable part of the spinal cord and less acceleration (force) is necessary to damage it than the other parts of the cord. The thoracic spinal cord is very well protected by the ribs and the chest. The lumbar cord is also very well cushioned by the abdomen. It therefore takes a lot of force to damage the thoracic spinal cord and most injuries of the thoracic and lumbar cord involve high-speed injuries that subject the the spinal cord high accelerations. Probably over 70% of cervical spinal cord injuries are "incomplete" while most thoracic and lumbar injuries are "complete". That may be why it seems that many people with cervical spinal cord injuries recover more.

    Wise.

  7. #217
    Quote Originally Posted by damagedgoods
    The top part of the cervical spinal cord is actually enlarged if I'm not mistaken, similar to the lumbar spinal cord. Pretty much the bottom and the top are the thick parts of the cord, since I assume they access and store information to be sent through the rest of the spinal cord.
    As cure is concerned, I don't think any part of the spinal cord is easier to cure than the other, and a cure, 100% cure, is most likely at least 40+ years away. What we can only hope for are tiny little improvements with quality of life issues in the next several decades. Hey, it's great to be optimistic, but I don't see where everyone is getting this cure idea from.
    Damaged, you may be right that no part of the spinal cord is easier to "cure". But I suspect that we are thinking of different reasons. You seem to think that the whole spinal cord has been damaged whereas I look at spinal cord injury as interrupting the connections between the brain and the spinal cord below the injury site. I don't know how to explain it in words and thus decided to draw a picture.

    In the picture below, sensory systems are in blue and motor is in red. If you had cervical spinal cord injury, it interrupts both motor and sensory connections in the neck. If you had thoracic spinal cord injury, it interrupts the motor and sensory connections in the thoracic spinal cord. The part of the axons (nerve fibers) that are disconnected by the injury will die. Regeneration means to regrow the nerve fibers. However, the targets of the motor axons or motoneurons should remain alive. Likewise, the targets of the sensory axons remain alive. Likewise, the neurons from which the motor and sensory fibers come from are also alive. So, the goal of regeneration is to regrow the axons from the injury site to their original targets. Many studies have shown that regeneration can occur in animals, that the obstacles to regeneration are threefold:
    1. The injury site itself is bereft of signals and cues for axonal growth. To solve that problem, we need to put cells that are attractive to axons at the injury site.
    2. Regeneration is very slow and the axons have to grow for many months. Therefore, we need to have a source of growth factors to stimulate the regeneration for long periods.
    3. The spinal cord contain several factors that seem to block regeneration. These include a protein called Nogo located on myelin (the membrane that normally wraps around and insulates axons) and an extracellular matrix protein called chondroitin-6-sulfate proteoglycan (CSPG). Nogo can be blocked, the nogo receptors on axons can be blocked, and CSPG can be degraded by an enzyme called chondroitinase.

    That is why there is hope that combination therapy with a cell transplant that is secreting growth factors, combined with Nogo blockers or chondroitinase will be effective in stimulating regeneration in the spinal cord. Animal studies suggest that these combination therapies will stimulate regeneration that restores function to animals. Nogo blockers are starting clinical trials. Many cell transplants are being tried. Many stem cells and olfactory ensheathing glia secrete growth factors. Finally, chondroitinase has been shown to stimulate regeneration in rat spinal cords.

    Wise.

  8. #218

    Post ok..what about this-

    What if a spinal cord injury was located on the tip of the Conus medullris, where there was no more of the cord beneath the injury, just the cauda equina. Am I correct in assuming that sensation could possibly be restored by trhese therapies, but motor could not? The brain tells this person to walk forward, but the messages are stopped in their tracks at the Conus injury, and their is no spinal cord left beneath, since it terminates, to make reconnections with cellular therapies. Am I making any sense here?
    how does the spinal cord surface at the injury site differ between let's say a laceration injury due to a vertebra slashing the cord, but not compressing it for a long period of time, due to the obviousness of the cause of injury and the doctors removing the verterbra, as opposed to a injury due to long periods of compression, with interupption of blood flow, from something like a vascular spinal cord malformation, AVM, not putting pressure on the nerve roots, but actually a intermedullary AVM, located right on the spinal cord's surface?

  9. #219
    Senior Member kickinglamb's Avatar
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    dear dr young,
    i'm a c-6 complete, 9 months post. i'm curious about how one would go about getting the special treatments, theprocedures to help prevent secondary conditions, such as [osteopouritis, cysts, more muscle wasting ect.
    and the special equipment, like pools, standing frames, ect. if your pt/ot/place doesnt have them. and how could i use them everyday if i don't own them?

    do you have to be independently wealthy or
    have super ins. not just medicare and medicade?

    i live in a small town 40 miles s. east of pgh.PAthere is ONE SCI DR in the pittsburgh area who accept my ins., i have lost faith and trust in him.
    my next appt. is monday.
    if you could please answer my 1st questions andd i'll give you a list of my symtems. please give me some idea how to talk to him, i would be ever grateful.

    ihave terrible neurological pain from my chest down it feels as though someone is burning my flesh with a blow torch while simutaniously cutting it up with razors.
    i always have excruciating pain in butt and back i'm assuming because i'm always on them.

    thank you i advance for your speddy reply,
    loori

  10. #220
    Quote Originally Posted by damagedgoods
    What if a spinal cord injury was located on the tip of the Conus medullris, where there was no more of the cord beneath the injury, just the cauda equina. Am I correct in assuming that sensation could possibly be restored by trhese therapies, but motor could not? The brain tells this person to walk forward, but the messages are stopped in their tracks at the Conus injury, and their is no spinal cord left beneath, since it terminates, to make reconnections with cellular therapies. Am I making any sense here?
    how does the spinal cord surface at the injury site differ between let's say a laceration injury due to a vertebra slashing the cord, but not compressing it for a long period of time, due to the obviousness of the cause of injury and the doctors removing the verterbra, as opposed to a injury due to long periods of compression, with interupption of blood flow, from something like a vascular spinal cord malformation, AVM, not putting pressure on the nerve roots, but actually a intermedullary AVM, located right on the spinal cord's surface?
    Damaged,

    A conus injury damages the lowest segments of the spinal cord, typically the sacral segments. Depending on the extent of damage, it may involve the lower legs, bladder, sexual function, and anal sphincter. Because the damage often includes the neurons that innervate these structures, neuronal replacement may be necessary.

    At the present, there are only two therapeutic approaches to replace neurons in the spinal cord. One is embryonic stem cells that have been predifferentiated to produce neurons can replace neurons, and then combined with treatment with cAMP or phosphodiesterase 4 inhibitors. The other is with fetal neural stem cells obtained from aborted fetuses. While there have been some reports that bone marrow stem cells can produce neurons in culture, no credible study has yet shown that transplanted bone marrow stem cells can produce neurons when transplanted into the spinal cord. I don't know how long it will take for the solution to be available but many laboratories are working on this problem. It is the central problem in many conditions where there has been loss of motoneurons. These include polio and other viral diseases that damage motoneurons and degenerative motoneuronal diseases such as amyotrophic lateral sclerosis.

    Laceration occurs when a sharp edge has cut into the spinal cord. This is rare. Compression is more common from bony compression of the spinal cord or disc compression of the spinal cord. Most surgeons will aggressively decompress a traumatically compressed spinal cord within several hours if it is possible to do so without surgery. However, for people who require surgery for decompression, the decompression may be delayed for 24 hours or longer. Compression of the spinal cord for prolonged periods is obviously not good for the spinal cord. Ischemia contributes to the damage, particularly gray matter (or the cells in the spinal cord), but some axons may survive the ischemia, leaving some residue sensation.

    You are talking about a lot of different conditions. As you know, an AVM is an arteriovenous malformation that may be either on the surface of the cord or inside the cord (intramedullary). An AVM typically causes the veins on the surface of the cord to enlarge. This is because the AVM feeds arterial pressure directly into the veins. Enlargement of the veins may compress the cord. But, more frequently, the damage to the spinal cord occurs when the AVM leaks blood or ruptures. When this happens and blood gets into the spinal cord, the blood may compress the cord and damage the spinal cord directly.

    Are these the answers that you are looking for? I am trying to guess what you want to know.

    Wise.

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