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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2015; 6(1): 42-55
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.42
Current and future medical therapeutic strategies for the functional repair of spinal cord injury
Tevfik Yılmaz, Erkan Kaptanoğlu
Tevfik Yılmaz, Department of Neurosurgery, Faculty of Medicine, Dicle University, Diyarbakır 21280, Turkey
Erkan Kaptanoğlu, Department of Neurosurgery, Faculty of Medicine, Near East University, Nicosia 99138, North Cyprus
Author contributions: Yılmaz T and Kaptanoğlu E contributed equally to this work; Yılmaz T and Kaptanoğlu E designed and performed the research, analyzed the data and wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tevfik Yılmaz, Assistant Professor, Department of Neurosurgery, Faculty of Medicine, Dicle University, the East of Diyarbakır, Diyarbakır 21280, Turkey. kartaltevfik@hotmail.com
Telephone: +90-412-2488001 Fax: +90-412-2488440
Received: October 24, 2013
Peer-review started: October 25, 2013
First decision: December 13, 2013
Revised: February 15, 2014
Accepted: April 25, 2014
Article in press: April 29, 2014
Published online: January 18, 2015
Processing time: 453 Days and 2.9 Hours
Abstract

Spinal cord injury (SCI) leads to social and psychological problems in patients and requires costly treatment and care. In recent years, various pharmacological agents have been tested for acute SCI. Large scale, prospective, randomized, controlled clinical trials have failed to demonstrate marked neurological benefit in contrast to their success in the laboratory. Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. Recently, attempted cellular therapy and transplantations are promising. A better understanding of the pathophysiology of SCI started in the early 1980s. Research had been looking at neuroprotection in the 1980s and the first half of 1990s and regeneration studies started in the second half of the 1990s. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs, and minimize the secondary damage caused by compression of the spinal cord after trauma. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.

Keywords: Spinal cord injury; Treatment; Pharmacological treatment; Trauma; Cellular treatment; Management

Core tip: In recent years, various pharmacological agents have been tested for acute spinal cord injury (SCI). Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.