Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma

1st Edition - February 17, 2022
Imprint: Academic Press
Editors: Michael Fehlings, Brian Kwon, Alexander R. Vaccaro, F. Cumhur Oner
Language: English
Hardback ISBN:
9 7 8 - 0 - 1 2 - 8 1 9 8 3 5 - 3
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 1 9 8 3 6 - 0

Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma provides readers with a comprehensive overview on the most up-to-date strategies to repair and regenerat… Read more

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Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma provides readers with a comprehensive overview on the most up-to-date strategies to repair and regenerate the injured spinal cord following SCI and spine trauma. With contributions by international authors, chapters put regenerative approaches in context, allowing the reader to understand the challenges and future directions of regenerative therapies. Recent clinical trial advancements are thoroughly discussed, with the impact of trial findings addressed. Additionally, major ongoing clinical trials are included with thoughts from experts in the field. Recent clinical practice guidelines for the management of traumatic spinal cord injury are featured throughout.

These guidelines are quickly being adopted as the standard of care worldwide, and the comprehensive information found within this book will place these recommendations in context with current knowledge surrounding spinal cord injury and spine trauma.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Editor bios
The sine qua non encyclopedia for spinal cord neurotrauma, spine trauma, and neurorehabilitation
Preface
Acknowledgments
Introduction
Chapter 1. Anatomy
Spinal column
Spinal nerves
Gray matter: nuclei and rexed lamina
White matter tracts
Vascular supply
Autonomic nervous system
Conclusion
Chapter 2. Epidemiology
Overview
History
Pediatrics
Resources
Prevalence
Incidence
Costs
Clinical
Etiology
Gender and age
Organized systems of care
Rehospitalizations
Neurological recovery
Survival
Chapter 3. Classification systems: spine trauma
Introduction
Cervical spine trauma classification systems
Upper cervical spine (occiput to C2)
Thoracolumbar classification systems
Sacral classification systems
Summary
Chapter 4. Classification systems: SCI
Introduction
Classification systems
Summary
Chapter 5. Outcome measures
Introduction
Imaging outcomes
Clinically determined outcome measures
Electrophysiological outcomes
Patient-reported outcome measures
Conclusions
Chapter 6. Imaging: spine trauma
Introduction
Cervical spine imaging indications
Patients who warrant imaging
Plain radiography (X-ray)
Computed tomography
Magnetic resonance imaging for the injured spinal column
Cervical spine clearance
Magnetic resonance imaging for spinal cord injury
Noteworthy cases
Imaging evaluation of vertebral artery injury
Summary
Chapter 7. Advanced imaging for spinal cord injury
Introduction
Conventional magnetic resonance imaging
Quantitative magnetic resonance imaging
Clinical applications
Conclusion and future directions
Chapter 8. Intraoperative imaging and image guidance
Evolution of computer-assisted navigation
Registration, imaging, and actuation techniques in spinal computer-assisted navigation
Intraoperative ultrasound
Chapter 9. Upper cervical spine and spinal cord injuries
Diagnostic considerations
Anatomy and injury classification
Upper cervical spine injury
Spinal cord injury in upper cervical spine injury
Prognosis after upper cervical spinal cord injury
Management of upper cervical spinal cord injury
Conclusion
Chapter 10. Spine trauma management issues: C-spine
Preoperative management
Operative management
Future considerations
Chapter 11. Spine trauma management issues: thoracic and lumbar
Introduction
Clinical evaluation
General management considerations
Specific management considerations by fracture subtype
Special considerations
Conclusion
Chapter 12. Spine trauma: sacral fractures
Introduction
Anatomy
Epidemiology
Classification
Evaluation
Treatment
Complications
Special considerations
Outcomes
Summary
Chapter 13. Spine trauma management issues: polytrauma
Take home points
Introduction
Conflicting priorities
Spine clearance
Primary versus secondary spinal cord injury in the setting of polytrauma
Cord perfusion and coagulopathy
Timing of fixation
Case examples
Chapter 14. Spine trauma in the elderly – management issues and treatment goals
Pathophysiology
Traumatic spinal cord injury
Central cord syndrome
Medical considerations in the geriatric spinal cord injured patient
Multimodality analgesia regimen
Cost-effectiveness of surgery in SCI
Vertebral compression fractures
Diffuse idiopathic skeletal hyperostosis
Conclusions
Chapter 15. Spine Trauma: areas of controversy and Emerging Concepts
Introduction
Management of AOSpine A3/A4 fractures: operative versus nonoperative
MIS versus open surgery for fractures without deformity
Operative management of type 2 odontoid fractures in the elderly
Timing of surgery for central cord syndrome
Role of MRI in decision-making for spine fractures
Conclusion
Chapter 16. Traumatic central cord injury
Introduction
Diagnosis and definition
Epidemiology
Pathophysiology
Clinical course
Management
Conclusion
Chapter 17. Management and pathophysiology
Epidemiology
Clinical management of spinal cord injury—standard of care in North America
Pathophysiology of spinal cord injury
Chapter 18. SCI management: role and timing of surgical intervention
Introduction
Natural history
The nature of surgical decompression for spinal cord injury
Timing of surgical decompression in cervical spinal cord injury
Timing of decompression in the “central cord” pattern of cervical incomplete tetraplegia
Timing of decompression in thoracic and thoracolumbar spinal cord injury
Timing in cauda equina injury
Current guidelines
Knowledge gaps surgical timing and recommendation for future research
Chapter 19. Intensive care and drugs after spinal cord injury
Introduction
Initial management
Timing of surgical decompression
Hemodynamic targets after SCI
Spinal cord perfusion pressure monitoring
Pharmacologic management of SCI
Extraspinal complications of SCI
Chapter 20. SCI management: rehabilitation
Introduction
Overview of the rehabilitation principles
Restoration of motor and sensory function
Minimizing secondary health conditions
Knowledge gaps and research opportunities
Chapter 21. Economic impact of traumatic spinal cord injury
Introduction
Economic burden of diseases
Current knowledge on cost-effective opportunities
Knowledge gaps and research opportunities
Chapter 22. Complications and adverse events following traumatic spinal cord injury
Introduction
Incidence and prevalence of complications in tSCI
Spectrum of complications in traumatic spinal cord injury
Impact of complications on neurological and functional recoveries
Mortality following traumatic spinal cord injury
The role of prediction models in evaluating patients' risk for complications
Conclusion
Chapter 23. Neurochemical biomarkers of acute spinal cord injury
Introduction
Promising neurochemical biomarkers of acute SCI
Chapter 24. Clinical trials: pharmacological approaches to enhance neural repair and regeneration after spinal cord injury
Introduction
Completed clinical trials
Drugs under active clinical investigation
Drugs entering clinical trials
Conclusion
Chapter 25. Clinical trials: cellular regenerative approaches
Introduction
Conclusion
Chapter 26. Clinical trials: noncellular regenerative approaches
Introduction
Conclusion
Chapter 27. Clinical trials: rehabilitation approaches
Background
Rehabilitative approaches to improve function after SCI
Conclusions
Chapter 28. Neuroprotective strategies: translational perspectives
Introduction
Excitotoxicity
Immunological modulation
Blood–spinal cord barrier maintenance
Other
Combinatorial strategies
Chapter 29. Translational perspective: neuroregenerative strategies and therapeutics for traumatic spinal cord injury
Introduction
Biologic therapeutics
Extrinsic determinants of neuronal regeneration
Intrinsic determinants of neuronal regeneration: the conditioning lesion paradigm
Cellular and acellular (biomaterial) transplant interventions
Summary
Conclusions
Chapter 30. Emerging concepts in the clinical management of SCI for the future
Introduction
Time is spine
Measures of spinal cord physiology
Integration of imaging data into predictive and prognostic models
Minimally invasive treatment modalities
Redefining clinical heterogeneity
Aging and frailty
A personalized approach to SCI management
Regenerative medicine
Interrogating neural circuitry to understand disease states
Application of brain–computer interfaces
Conclusion
Chapter 31. Translational research in spinal cord injury – What is in the future?
Introduction
Epidemiologic changes
Clinical considerations
Personalized approaches
Future perspectives in neuromodulation
Future perspectives related to artificial intelligence
Conclusion
Index

Michael Fehlings

Dr. Fehlings is the Vice Chair Research for the Department of Surgery at the University of Toronto and Head of the Spinal Program at Toronto Western Hospital, University Health Network. Dr. Fehlings is a Professor of Neurosurgery at the University of Toronto, holds the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration, is a Scientist at the McEwen Centre for Regenerative Medicine and a McLaughlin Scholar in Molecular Medicine. In the fall of 2008, Dr. Fehlings was appointed the inaugural Director of the University of Toronto Neuroscience Program (which he held until June 2012) and is currently Co-Director of the University of Toronto Spine Program. Dr. Fehlings combines an active clinical practice in complex spinal surgery with a translationally oriented research program focused on discovering novel treatments to improve functional outcomes following spinal cord injury (SCI). He has published over 850 peer-reviewed articles (h-index 87) chiefly in the area of central nervous system injury and complex spinal surgery. His seminal 1991 paper, cited over 1400 times, outlined the severe and lasting consequences of SCI due to a cascade of secondary injury mechanisms following the initial trauma. His research on secondary injury mechanisms ultimately led to the commencement of the multicenter, international Surgical Timing in Acute Spinal Cord Injury Study (STASCIS), aimed at establishing the need for early surgical decompression to prevent the negative effects of the secondary injury cascade. The results from this study, led by Dr. Fehlings and published in 2012, demonstrated the critical importance of early surgical decompression (<24 hours) to improve functional and neurological outcomes, and reduce secondary complications in individuals with SCI. His work examining the use of regenerative approaches including neural stem cells to repair the injured nervous system has led to numerous international awards and has helped lead the field toward clinical translation in this area. In 2017, the initiative to create Clinical Practice Guidelines for the management of degenerative cervical myelopathy and acute traumatic SCI – a multi-disciplinary international effort led by Dr. Fehlings - was published in the Global Spine Journal. Most recently, Dr. Fehlings’ work demonstrating that midcervical excitatory interneurons are essential for the maintenance of breathing in non-traumatic cervical SCI and critical for promoting respiratory recovery after traumatic SCI was published in Nature. Dr. Michael Fehlings has received numerous prestigious awards including the Gold Medal in Surgery from the Royal College of Physicians and Surgeons (1996), nomination to the Who’s Who list of the 1000 most influential scientists of the 21st century (2001), the Lister Award in Surgical Research (2006), the Leon Wiltse Award from the North American Spine Society for excellence in leadership and/or clinical research in spine care (2009), the Olivecrona Award (2009) -- the top award internationally for neurosurgeons and neuroscientists awarded by the Nobel Institute at the Karolinska Institute in Stockholm for his important contributions in CNS injury repair and regeneration, the Reeve-Irvine Research Medal in Spinal Cord Injury (2012), the Golden Axon Leadership Award (2012), the Mac Keith Basic Science Lectureship Award for significant contributions to the basic science of cerebral palsy and childhood onset disabilities (2012), and was the Mayfield Lecturer (2012). In 2012, Dr. Fehlings served as the 40th President of the Cervical Spine Research Society (CSRS) -- the only Canadian to do so -- and was honoured with the CSRS Presidential Medallion for outstanding leadership and contributions to cervical spine research. In 2013, Dr. Fehlings was honoured with the Queen Elizabeth II Diamond Jubilee Medal presented to him by the Honourable Stephen Harper, the H. Richard Winn Prize from the Society of Neurological Surgeons, the Jonas Salk Award for Scientific Achievements from the March of Dimes Canada and the Henry Farfan Award from the North American Spine Society. In 2014, Dr. Fehlings was elected to the Fellowship of the Royal Society of Canada and to the Canadian Academy of Health Sciences, and in 2016 won the Royal College of Physicians and Surgeons Mentor of the Year Award.

Affiliations and expertise

Robert Campeau Family Foundation-Dr. CH Tator Chair in Brain and Spinal Cord Research

Brian Kwon

Dr. Kwon is a surgeon-scientist with advanced training in spine surgery and also a PhD in neuroscience. He is a Professor in the UBC Department of Orthopaedics. As an attending orthopaedic spine surgeon at Vancouver General Hospital his practice is focused on the management of adult spine trauma, spinal cord injuries, and non-traumatic conditions such as spine infection, deformity, and degeneration. As a neuroscientist and Principal Investigator at ICORD, Dr. Kwon runs an active basic/translational research laboratory. Dr. Kwon is currently also serving as the Associate Director, Clinical Research, for ICORD, and is the Associate Scientific Director of the Rick Hansen Institute.

Affiliations and expertise

Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada

Alexander R. Vaccaro

Dr. Vaccaro has served as the president of Rothman Orthopaedics since 2014 and is the Richard H. Rothman Professor and Chairman in the Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University in Philadelphia, Pennsylvania. He was the recipient of the Leon Wiltse award given for excellence in leadership and clinical research for spine care by the North American Spine Society (NASS) and is the past President of Cervical Spine Research Society (CSRS), the American Spinal Injury Association and the Association for Collaborative Spine Research. He is currently a member of the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors. He has over 900 peer-reviewed and 200 non-peer reviewed publications. He has published over 372 book chapters and is the editor of over 63 textbooks and co-editor of OKU-Spine I and editor of OKU-8. Dr. Vaccaro also serves as Co-Director of the Regional Spinal Cord Injury Center of the Delaware Valley.

Affiliations and expertise

Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery, Professor of Neurosurgery, Sidney Kimmel Medical Center of Thomas Jefferson University, Co-Director, Delaware Valley Spinal Cord Injury Center, President, Rothman Orthopaedics, Philadelphia, Pennsylvania, USA

F. Cumhur Oner

Cumhur Öner obtained in 1980 his Medical Degree in Ankara, Turkey and did his orthopaedic surgery training in Rotterdam between 1987 and 1993. Since 1993 he works as an orthopaedic spine surgeon at the University Medical Centre Utrecht. He obtained his PhD (cum laude) in 1999 from the University of Utrecht. The work for his PhD thesis focused on the diagnostic and prognostic parameters in spinal trauma patients. He is the head of the neuro-orthopaedic spine unit since 2002. Cumhur Öner has actively participated in the foundation of the international Spine Trauma Study Group and is currently member of the steering committee of the Knowledge Forum Trauma of the AOSpine International. He has been involved in clinical spine research as well as the bone and intervertebral disc RM program in the UMC Utrecht. He was the president of the Dutch Spine Society between 2007-2011.

Affiliations and expertise

University Medical Centre Utrecht, Utrecht, The Netherlands

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Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma

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