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Thread: What kind of "cure" would "fit" me? Dr.Wise or anyone else:)? any suggestions?

  1. #1

    Question What kind of "cure" would "fit" me? Dr.Wise or anyone else:)? any suggestions?

    Hello everyone!

    Not sure if this is the right forum but ill try anyways

    First, thank you for a great forum where ive learned alot allready.

    I was diagnosed recently with something called a tethered cord syndrome which comes from something called spina bifida occulta, which is a very minor form of spina bifida (open spine).

    Surgery was a success (releasing the cord, s1 to s5 roots intact) MRI showed no abnormal amount of scar tissue, bleeding etc. Still im quite abit worse now about 8 months post surgery than before. Over the years i think ive gotten some chronic injury due to my condition, affecting mostly bowel release reflexes and bladder (slowy over many years crept up on me).

    I know that its still early to say if i get back to where i was or perhaps even improve.

    So any ideas on what kind of future therapy could be beneficial? Not the easiest question to answer i guess, but if i dont try i wont get any answers at all.

    Oh and could my SCi be seen as a form of contusion injury since basically my SC is "stretched" not cut or severed in any way?

    Abit late so hoping this makes any sense?

    Best Regards

    Bengt Møller

  2. #2

    From your description, I am assuming that you had tethering of your spinal cord and not just your roots. This makes a difference because spinal cord injury and spinal injuries may require different treatments or at least different approaches. It is difficult to know how much damage you have had from symptoms alone. When the injury occurs over a long time, quite a bit of damage could have occurred with minimal symptoms.

    Many people seem to believe that there will be a single "cure" for spinal cord injury. I don't believe that this is so. There will likely to be therapies that will address individual problems that may or may not b present in the spinal cord. It is useful to think of spinal cord injury in terms of the problems that we are trying to reverse.

    1. Spinal axonal injury. About 70% of the spinal cord consist of nerve fibers or axons that course up and down the spinal cord, linking the brain and the spinal cord. Loss of these axons disconnects the brain from the spinal cord. The neurons that originate the axons are usually still intact but their axons are no longer connecting. The solution to this is regeneration, to regrow the axons from the injury site back down to the original points of connection. Two observations make me confident that regeneration is not only possible but will restore function in people with spinal cord injury. First, the spinal cord can function with about 10% of its connections. Most people, even those with so-called "complete" spinal cord injuries, still have some axons. Therefore, we do not need to regenerate the whole spinal cord in order to get substantial function back. Second, the spinal cord is incredibly "plastic" and can utilize connections that may not be exactly the same as before.

    2. Neuronal loss. The cervical and lumbosacral spinal cord contain neurons that control the arms and legs/sacral organs. Injuries to these parts of the spinal cord can cause loss of neurons. Recent studies suggest that stem cells may be able to replace neurons. In particular, some studies suggest that embryonic stem cells that have been differentiated into neural precursor cells can replace motoneurons and be encouraged with growth factors and other treatments to reconnect to muscles. If so, this is very exciting and may present a solution to the problem of neuronal replacement in spinal cord.

    3. Demyelination. In order to conduct rapidly, axons have to be myelinated. Myelin is produced by a cell called oligodendroglia and they are sensitive to trauma, ischemia (loss of blood flow), inflammation (transverse myelitis), and immune attack (like in multiple sclerosis). Many cells that now been reported to remyelinate the spinal cord, including oligodendroglial precursor cells obtained from embryonic or fetal stem cells, Schwann cells, and olfactory ensheathing glia.

    4. Spinal root damage. The spinal roots contain sensory fibers that come from the dorsal root ganglia outside of the spinal cord and motor fibers that come from motoneurons in the spinal cord. When injury has occurred to the spinal roots between the dorsal root ganlia and the spinal cord, sensory recovery is frequently limited, even though peripheral nerves can regenerate to some extent, because the sensory axons do not penetrate well into the spinal cord and regrow all the way back the the brain. There may be limited motor nerve regeneration but If there is scarring in the area of the spinal root damage, such regeneration may be very limited.

    5. Neuropathic pain and spasticity. These result from abnormal excitability of neurons above and below the injury, due to loss of neuronal connections. About half of people with spinal cord injury develop one or both of these problems. They represent abnormal excitability of neurons. Presumably regeneration and reconnection will help reduce these problems but at the same time, there is concern that treatments may cause abnormal and inappropriate reconnections that may contribute to both pain and spasticity.

    6. Autonomic dysfunction. The spinal cord is the source of much sympathetic and parasympathetic control. Autonomic functions such as temperature control, bladder and bowel, and blood pressure are controlled by a balane of sympathetic and parasympathetic systems. While most people recover these functions to some extent with time after an "incomplete" injury, the recovery may take years and there is often significant dysfunction and imbalance. So, the solution to this problem is targeted regeneration to restore autonomic control and balance.

    While cell transplants are being done around the world, the number and types of cells that are available for transplantation are limited. Given the squabbles that are going on with embryonic and fetal stem cells, I suspect that both of these will be slow to reach clinical trials in the United States. Some overseas clinics are using these sources of cells but the trials are generally not well done and the cells that are being transplanted are poorly characterized. Umbilical cord blood and bone marrow cells are available for transplantation but the evidence that they are effective is still very limited. Furthermore, many animal studies are suggesting that cell transplants alone may not be sufficient and that combination therapies with cell transplants, prolonged growth factors, and growth inhibitor blockers will be necessary to restore substantial function.

    A contusion injury implies rapid deformation of the spinal cord, at velocities exceeding 0.5 meters per second. What you have is probably a form of compression injury since tethering of the spinal cord constricts the tissue and chronic compression damages the spinal cord by restricting blood flow. Ischemia often damages the neurons, which are most sensitive to blood flow loss. But, it is unclear to me what your symptoms are and where you were injured, so the above is highly speculative. People may have combinations of all or some of the problems


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