Complications after spinal cord injury

What are the complications of the spinal cord injury and where are we now? The number of the patients with severe spinal cord injuries keeps growing all the time. This is conditioned by an increase in the number of local military conflicts, natural disasters and car accidents around the world. Household injuries and sport and diving injuries also play an important role in the growth in the number of brain injuries. The old principles of Hippocrates that it is necessary to treat an acute injury, and not its consequences or that injury is terrible not for its present, but for its consequences are still relevant today. Currently, there are no real technologies for the treatment of SCI complications. In fact, severe SCIs form a severe traumatic disease or a disease of the damaged brain. Regardless of the extent of the injury and its nature, after 2 to 3 years, the brain reacts with a cyst, scar and atrophy of the nervous tissue, or combined cicatricial-degenerative process. It is not rare when the metal plates that have been implanted to fix the spine, damage the spinal cord with their screws. The body’s own resources for the restoration of brain tissue are practically exhausted by the end of the second year.

Types of patients: the individuals aged over 18 with residual neurological disorders after severe spinal cord injury (SCI), independent on the time of injury and localization.

The principle of therapy: Trauma-induced death of cells that constitute the normal structure of the tissues of the spinal cord, leads to the damage of the function of the corresponding parts of the spinal cord and disability of the patient. At the site of injury, the conditions are unfavorable for tissue regeneration, which is associated with the disruption of vascular trophism (provision), the formation of glial scars, which leads to local production of inflammation supporting tissue factors and cytokines. As a rule, specialized blood circulating cells, which under normal conditions provide tissue repair after damage, do not penetrate the blood-brain barrier that separates the brain and spinal cord from the vascular bed, and thus they do not participate in regeneration. Figuratively, one can imagine that the damaged areas lack «building» personalised material. As a result, the lost functions do not recover or they restore extremely slowly, even despite active drug treatment and modern rehabilitation programs.

The administration of autologous CD34+ fraction of the patient's peripheral blood mononuclear cells (PBMCs), including progenitor cells, bypassing the blood-brain barrier, allows not only to provide the damaged areas with the necessary "building" material, but also to affect the local personalised repair mechanisms of regulation. The administration of autologous (patient’s own) cells of an adult type does not carry any risks of developing tumors, immunological rejection reactions or transmission of viral and other latent (hidden) infections.

We have been using therapy in SCI for 30 years and cancer has been noted in none of the cases.

Method: At the first stage, the CD34+ fraction of the peripheral blood mononuclear cells (PBMCs) is harvested from the patient on a cell separator, using a disposable system. One séance provides the material that is sufficient for the long-term restorative therapy for 12 to 18 months. The obtained cell material is preserved at low temperature. Before administration, the cells are thawed and are introduced by spinal tap behind the blood-brain barrier with an interval of 1 to 2 weeks. The cells migrate in the cerebrospinal fluid to the sites of injury and brain tissue to the central neurons of the brain and spinal cord to provide axonal transport and neural restoration.

Result. Active specialized rehabilitation aimed at the development of new function provides for even better functional results against the therapy and improves the neurological motor functions in 46 to 51% of the patients depending on the type and duration of injury; neurological functions of sensation improve in up to 60% of the cases, while the function of the pelvic organs restores in 45%. Over 10 000 patients from 50 countries of the world have been treated in our hospital.