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Cure and Spinal Cord Injury

CURE and Spinal Cord Injury in the Medical Literature

 

December 1, 2001

 

Wise Young, Ph.D., M.D., Professor & Director

W. M. Keck Center for Collaborative Neuroscience

Rutgers University, Pisacataway, NJ 08854-8082

 

How long have scientists and clinicians been using the word “cure” in connection with spinal cord injury?  To answer this question, I did a literature search for all medically related articles that referred to cure of spinal cord injury from 1950 through 2001.  A Medline search revealed 139 articles that contained the both "cure" and "spinal cord injury" in the title, abstracts, or keywords.  In contrast, 23,534 articles contained the words “spinal cord injury” and 26,356 articles contained the word “cure”.  Thus, less that 0.6% of the medical articles on spinal cord injury published since the 1950’s contain the word “cure” in conjunction with spinal cord injury and less than 0.5% of the medical articles referring to “cure” were related to spinal cord injury.  A closer look at the 139 articles revealed only 3 articles before 1990 that actually referred to cure of spinal cord injury, 5 articles in the 1990’s, and 8 articles in 2000-2001.  Clinicians and researchers were clearly reluctant to use the word “cure” in relationship to spinal cord for many years.  In over 23,000 articles on spinal cord injury, only 16 referred to cure of the condition in the title or abstract.  However, there is a trend for increasingly optimistic references to curing spinal cord injury.  In the first two years of the new millennium, we have had 7 articles that referred to cure of spinal cord injury optimistically, more than the entire medical literature before 2000.  

The Dark Ages of Spinal Cord Injury

Before 1990, only 20 articles in the medical literature contained the words “cure” in conjunction with the words “spinal cord injury”.  In the 1960’s, the word “cure” does not appear with spinal cord injury in any listed article.  This may be because Medline does not have most of the abstracts from articles from the 1960’s.  In the 1970’s, the word cure appears in conjunction with spinal cord injury only 7 times but only referring to associated conditions or procedures rather than spinal cord injury itself, i.e.  angiomyolipoma [1], vertebral sciaticas [2], Ewing’s tumor [3], arthritic lumbar canal narrowing [4], arachnoiditis [5], pseudomyotomy [6], and external sphincterotomy [7].

In the 1980’s, the terms “cure” and “spinal cord injury” appeared in 13 articles.  Most referred to associated conditions rather than to spinal cord injury itself, i.e. spinal epidural hematoma [8], syringomyelia [9], cancer affecting the spinal cord [10], osteomyelitis [11,12], pain [13], urinary tract infections [14,15], disc disease [16], and hyperbaric oxygen therapy of other conditions including spinal cord injury [17]. 

A 1980 article by Kelly [18] was the first article that I could find that directly referred to curing spinal cord injury, i.e. “The person with a spinal cord injury and paralysis rarely loses the hope that a cure might be the next great discovery of medical science and active spinal cord injury research centers have the same goal”.  In 1983, Stover [19] pointed out that  “We would all like to see  cure.  We must not be satisfied, however, with the status quo of care until a cure is possible” while Dewis & Tenn [20] argued for preventing spinal cord injury in the context of past efforts “directed towards minimising the effects of the injury, optimising rehabilitation and search for a cure”.  Although the concept of curing spinal cord injury was acknowledged, most people thought of it only as a distant future possibility.

The Decade of the Spinal Cord

Congress proclaimed the 1990’s the Decade of the Brain but, in many ways, it was the Decade of the Spinal Cord.   In 1990, the first neuroprotective therapy (methylprednisolone) was reported to improve functional recovery in human spinal cord injury.  The first regenerative therapies and remyelinative therapies were reported for spinal cord injury during this decade, as well as the discovery of neural stem cells boosted hope for spinal cord injury research.  One might have expected increasing reference to curing spinal cord injury in the medical literature.

The Medline search revealed 78 articles that contained the words “cure” and “spinal cord injury” in the 1990’s.  However, 57 of the article came from the Miami Project to Cure Paralysis [21-77].  Many of the articles also used the word “cure” only in the context of treating spinal cord injury complications, i.e. urinary tract infections [78-80], rheumatoid discs [81], pain [82], treatments of spinal tumors [83-88], irritable bowel syndrome [89], Pott’s disease [90], hydatid disease [91], cervical spondylopathy [92], urethral stents to treat detrusor-sphincter dyssynergia [93]. 

Only four articles in the 1990’s referred to the possibility of curing spinal cord injury and mostly from a pessimistic viewpoint.  Bedbrook [94] emphasized prevention and rehabilitation because “cure is many decades away even with the volume of basic research now being undertaken”.  Privat, et al. [95] spoke of a “search for the cure for paralysis”.  Ditunno & Formal [96] spoke of the need to maintain health so that people can take advantage of “opportunities for neurologic improvement or cure”.  Matera [97] felt that “a cure still seems elusive” and that “prevention is still the key”.  Kakulas [98] referred to the need to understand the anatomy of spinal cord injury in the search of a “cure”.  Thus, it seems clinicians and scientists were still reluctant to refer to curing spinal cord injury during the 1990’s. 

The Cure Millennium

Even in the last two years, the word cure was rarely used in conjunction with spinal cord injury in the published medical literature.  If we eliminate articles that had the word “cure” only in institutional titles [99-121], and articles referring to cures of only of associated conditions, such as urinary tract infections [122-127], spinal tumors [128], and infections of the spine [129], we end up with only eight articles referring to curing spinal cord injury.  One article was pessimistic, i.e. O’Connor [130] who said, “As there is no cure for SCI, and the level of impairment does not improve substantially for the vast majority of cases even after rehabilitation, it is arguable that primary prevention should receive substantially greater emphasis”. 

Most of the articles, however, were optimistic.  Dumont [131] referred hopefully to the search for cure.  Girardi [132] suggested that although a “cure for spinal cord injuries does not currently exist, advances have been made in the field of spinal cord regeneration.”  Holsebosch, et al. [133] reviewed the “epistemology of cure” and “five essential processes required”.  Kleitman [134] described the search for a cure at the Miami Project to Cure Paralysis.  Krishnan, et al. [135] referred to optimism for cure in the past decade.  Murray & Fischer [136] likewise spoke “remarkable developments from many disciples… that… have generated a new wave of optimism in the search for a cure for CNS injury and in particular spinal cord injury”.  Finally, Raisman [137] asked whether olfactory ensheathing glial cells represent a cure for spinal cord injury.

Clearly, scientists and doctors have been reluctant to use the word “cure” in their publicatons.  The Medline search found 23354 articles that contained the term “spinal cord injury”, 26656 articles that contained the term “cure”, and 139 article that contained both.  Less than 0.6% of spinal cord injury articles referred to cure.  Of these, 15 referred directly to cure of spinal cord injury.  Over half of these articles were published in the last two years, compared to the last 50 years of medical literature.

Number of Medical/Research Articles on “cure” and “spinal cord injury”

 

SCI

Cure

SCI+Cure

Associated

Institution

Cure of SCI

1950-1979

 

 

7

7

0

0

1980-1989

 

 

13

10

0

3

1990-1999

 

 

78

17

57

4

2000-2001

 

 

41

11

22

8

Total

23534

26356

139

45

79

15

Explanation:  This table lists the number of articles from Medline searches of the medical literature (1950-2001), split into decades.  The columns list the number of articles that contained “spinal cord injury” (SCI), “cure” (Cure), both (SCI+Cure), both but focused on associated conditions (Associated), both but the word cure was in the institutional title (Institution), and direct references (Cure of SCI). 

Summary

In over 50 years of medical literature published between 1950 and 2001, I found only 139 articles that contained the terms “cure” and “spinal cord injury” in the title or abstract.  Of these articles, most referred to curing associated conditions or had the word “cure” in their institutional title.  Only 16 articles referred explicitly to curing spinal cord injury.  None were published before 1980, 3 in the 1980’s, 5 in the 1990’s, and 8 in 2000-2001.  No articles before 1990 was optimistic about a cure for spinal cord injury, only one in the 1990’s, and 7 in 2000-2001.  Clinicians and scientists are reluctant to use the word “cure” in connection with spinal cord injury but there is a trend towards increasing use of the word in the medical literature.

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102.    Brackett NL, Lynne CM (2000). The method of assisted ejaculation affects the outcome of semen quality studies in men with spinal cord injury: A review. NeuroRehabilitation 15: 89-100.

103.    Brackett NL, Lynne CM, Aballa TC, Ferrell SM (2000). Sperm motility from the vas deferens of spinal cord injured men is higher than from the ejaculate. J Urol 164: 712-5.

104.    Bruce JH, Norenberg MD, Kraydieh S, Puckett W, Marcillo A, Dietrich D (2000). Schwannosis: role of gliosis and proteoglycan in human spinal cord injury. J Neurotrauma 17: 781-8.

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