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[Transplantation of olfactory ensheathing cells after spinal injury. II--Experimental variability and clinical perspectives].

Over recent years, a certain number of experimental investigations have studied the effect of the transplantation of olfactory ensheathing glial cells (OEC) after spinal traumatism in animal, the rat in particular. Some of these studies have reported improvements in motor (mainly locomotor, postural and respiratory) and sensory function. While these new data provide additional support for the interest of the strategy of EOC transplantation to minimise the incapacitating effects of spinal pathologies in clinical therapy, it nonetheless remains necessary to continue experiments on animal models in order to better understand and master certain important points: beneficial effects according to the nature and composition of the transplants; therapeutic impact according to the type of pathology and the nature of the traumatism; influence of the dose effect; migration of the transplanted OECs (distance, pathways); active principles of the transplants; beneficial effect on various functions, in particular at the level of the vesico-sphincteric area; long-term innocuousness; long-term posttraumatic efficacy. Although therapeutic trials are in progress in certain countries (Australia, China, Portugal), it would nonetheless appear essential that these somewhat obscure points should be better understood before any clinical application might be seriously envisaged, in order to respect the principles of precaution, maximum efficacy and observance of the prevailing ethical rules.

Animals↗

Bodysurfing accidents resulting in cervical spinal injuries.

During the summers of 1987 and 1988, 14 cervical spine injuries sustained during bodysurfing accidents at the beaches around Ocean City, Maryland presented to our Neurotrauma service. All the patients were men, predominantly in their middle years (mean age = 40), and otherwise healthy. Likely mechanisms of injury suggested by radiography and computed tomography-myelography included hyperflexion, hyperextension, and axial loading. Clinically, neurologic deficits were found in 10 patients (71%), of whom 2 were complete sensorimotor quadriplegics below the level of injury, and 8 were incomplete injuries. Of the eight incomplete injuries, two-thirds were central cord syndromes associated with narrow spinal canals and prominent osteophytes, and one-third had Brown-Sequard or anterior cord syndromes. After initial anatomic realignment by closed or open reduction, the injured cervical spines were stabilized either externally or internally. Two patients underwent laminectomies. These bodysurfing accidents, in marked contrast to other types of shallow water-diving accidents, predominantly involved older men and produced incomplete injuries. It is concluded that bodysurfing is peculiarly hazardous to healthy, middle-aged men, especially those endowed with a narrow spinal canal with or without osteophyte formation.

Adult↗

Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries: longitudinal changes in maximal overground walking speed.

This study investigated the changes in maximal overground walking speed (MOWS) that occurred during walking training with a functional electrical stimulation (FES) orthosis by chronic spinal cord injured persons with incomplete motor function loss. The average walking speed over a distance of 10 m was calculated while the participants (n = 14) used their FES orthosis with and without power as well as with the various ambulatory assistive devices available. Within the first year of use, walking with an FES orthosis facilitated use of more advanced ambulatory assistive devices (10/14), improvements in functional mobility (12/14) and increases in the combined (0.26 m/s) and therapeutic (0.25 m/s) MOWS that were correlated (combined: r = 0.57; therapeutic: r = 0.69) with their respective initial MOWS. A longitudinal analysis showed that increases in MOWS followed a pattern of changes best described by either an exponential association (8/12) or a linear (4/12) model. These changes were similar for the combined and therapeutic MOWS (7/11) as well as for the different ambulatory assistive devices (8/9). It is concluded that the increased MOWS during walking training using the FES orthosis is mostly due to a therapeutic effect, implying that mechanisms of plasticity occur during such a training paradigm.

Adult↗