Patients & Families

What happens after a spinal cord injury?

What happens after a spinal cord injury?

Acute spinal cord injury (SCI) is frightening and traumatic. Early surgery is typical in order to decompress and stabilize the spine. This is done to decrease further damage. Even if the spine is successfully stabilized, however, the initial injury can lead to a cascade of complications.

It may become difficult or impossible for the brain to transmit signals to body parts below the site of injury. Often, that leads to partial or complete paralysis; patients may find they are unable to move their legs or to control typically automatic functions such as bladder, bowel and sexual function.


Here’s a look inside the spinal cord at the complications that can lead to paralysis:

Healthy spinal cord
Healthy spinal cord

Like the brain, a healthy spinal cord contains both gray and white matter. The gray matter sits in the butterfly-shaped center of the cord; it contains neurons that transmit messages from the brain to muscles, controlling movement. The white matter surrounding the butterfly contains bundles of nerve fibers that help carry motor and sensory information throughout the body.

2 hours after SCI
2 hours after SCI
  • Misplaced vertebrae fragments exert force on the spinal cord, leading to vascular injury.
  • Within two hours, acute hemorrhaging damages the neural tissue.
24 hours after SCI
24 hours after SCI
  • Within 24 hours, blood flow to the affected area is severely diminished, causing further damage to bone, tissue and neurons.
  • Within days, the white matter in the spinal cord begins to die. This white matter is the crucial “wiring” of the spinal cord; it consists of myelinated axons that transmit information from the brain to all parts of the body. The myelin, which shields the axons and is essential for signal conduction, begins to degrade.
12 weeks after SCI
12 weeks after SCI
  • Glial cells migrate to the site of injury and try to repair the damage, creating a scar. This “glial scar” becomes both a mechanical and chemical barrier, cutting off transmissions to and from the brain.
  • Within 12 weeks, a cyst may develop at the site of the injury. Very little, if any, white matter or neural tissue survives. Communication from the brain to the parts of the body below that cyst is cut off or severely impaired.

How is spinal cord injury assessed?

The American Spinal Injury Association (ASIA) Impairment Scale (AIS Scale) is used to assess a patient’s sensory and motor function. The neurological assessment underlying the AIS scale results in five grades on the scale, running from A (complete paralysis) to E (normal function).

Clinicians typically assess sensory function by applying pressure (both light touch and a sharper pin prick) to specific points throughout the body. Motor function is evaluated in each muscle group to assess both the range of motion and the patient’s ability to move against gravity and against moderate resistance.

Improving even 1 to 2 grades on the scale in the months following injury can make a significant difference in the patient’s quality of life.


Impact of spinal cord injury

Spinal cord injuries are often extremely serious. There are no available treatments to reverse the injury or erase the damage caused by impact to the spinal cord. The standard of care – surgery to stabilize the spine – is designed primarily to prevent further injury.

We are seeking to expand treatment options available to patients by investigating whether the Neuro-Spinal Scaffold can promote cell regeneration at the injury site. Physical therapy or other forms of physical rehabilitation are also necessary components of patient recovery.

Our goal is to improve the quality of life for spinal cord injury patients. To achieve greater gains, we expect a multi-disciplinary approach will be required, with the scaffold serving as a foundation for complementary technologies. We are exploring the potential to use our learnings gained from the scaffold in conjunction with stem cells, electrical stimulation or therapeutics.

Restoring even a small measure of control can be transformative

What does success in spinal cord injury treatment look like? For a patient with complete lower limb paralysis, regaining the ability to control one’s own bladder and bowels, and sexual function is life changing.


Our clinical trial

Following the results in our first clinical trial, we have initiated the INSPIRE 2.0 clinical trial to assess the overall safety and probable benefit of the Neuro-Spinal Scaffold for the treatment of thoracic traumatic acute spinal cord injury.

For more information about the INSPIRE 2.0 clinical trial:
https://clinicaltrials.gov/ct2/show/NCT03762655

California

UC Davis Medical Center (Sacramento)

University of California San Diego (San Diego)

Colorado

University of Colorado Memorial Hospital Central (Colorado Springs)

Florida

The University of South Florida, Tampa, FL

Iowa

University of Iowa (Iowa City)

Maryland

University of Maryland Medical Center (Baltimore)

Massachusetts

Brigham and Women’s Hospital (Boston)

New Jersey

Rutgers, The State University of New Jersey, Newark, NJ

New York

Elmhurst Hospital Center (Elmhurst)

Icahn School of Medicine at Mount Sinai (NY)

North Carolina

Vidant Medical Center (Greenville)

Oregon

Oregon Health & Science University (Portland)

Pennsylvania

Penn Presbyterian Medical Center (Philadelphia)

Thomas Jefferson University (Philadelphia)

University of Pittsburgh Medical Center-Presbyterian (Pittsburgh)

Rhode Island

Rhode Island Hospital (Providence)

Wisconsin

Medical College of Wisconsin (Milwaukee)


Resources

The following groups offer support and guidance for people living with spinal cord injury: