Abstract
Over the past half century there have been few therapeutic breakthroughs for the treatment of spinal cord injuries. It has been previously shown that following a Spinal Cord Injury (SCI), scar tissue develops at the site of injury through which axons are unable to penetrate to make appropriate neurological connections into the distal spinal cord. Over the past few years it has been reported that placing the omentum directly on a traumatized spinal cord can result in a favorable clinical result. The omentum has been shown to limit the development of scar tissue following SCI, which strongly suggests that omental transposition to an SCI now appears warranted to justify a carefully controlled evaluation of the benefits of omental application to an SCI. Spinal cord injuries are devastating events. Unfortunately, in spite of improved medical and surgical treatment of the condition, there has not been a significant improvement in the neurological results of these injuries during the past half century. The purpose of this paper is to suggest a surgical technique that might increase functional improvement in the future treatment of spinal cord injuries (SCI). A new approach to the problem seems warranted. Over a hundred years ago, Ramon y Cajal, the famous neuro-histologist, stated that axons are unable to connect to neural structures distal to an SCI based on his observations that axons cannot penetrate through scar tissue which routinely develops at the site of an SCI [1]. A half century later, Dr. L.H. Freeman, confirmed Cajal’s observations by showing that axons had the inherent capacity to grow distally within an injured spinal cord (SC), but their progress routinely encountered a scar barrier in which axons “simply form neuromata at the injury site” [2]. Based on these observations, if neuro-protection within an SCI is to be addressed, laboratory and clinical efforts should be increasingly aimed at preventing the development of scar tissue in an acute SCI and decreasing the scar barrier present in a chronic SCI.
Highlights
Over the past half century there have been few therapeutic breakthroughs for the treatment of spinal cord injuries
Spinal cord cooling appears to be inapplicable in the treatment of chronic spinal cord injuries since hypothermia would not be expected to break down scar tissue already present at the site of Spinal Cord Injury (SCI)
The long-term unfavorable neurological results that frequently occur following an SCI appear to be due to the scar formation that develops in an SCI
Summary
Over the past half century there have been few therapeutic breakthroughs for the treatment of spinal cord injuries. A half century later, Dr L.H. Freeman, confirmed Cajal’s observations by showing that axons had the inherent capacity to grow distally within an injured spinal cord (SC), but their progress routinely encountered a scar barrier in which axons “ form neuromata at the injury site” [2]. Freeman, confirmed Cajal’s observations by showing that axons had the inherent capacity to grow distally within an injured spinal cord (SC), but their progress routinely encountered a scar barrier in which axons “ form neuromata at the injury site” [2] Based on these observations, if neuro-protection within an SCI is to be addressed, laboratory and clinical efforts should be increasingly aimed at preventing the development of scar tissue in an acute SCI and decreasing the scar barrier present in a chronic SCI. As the volume of edema accumulates in an injured SC, there is eventual blockage of the central canal, subarachnoid and subdural spaces so that the normal edema drainage system within the spinal cord is compromised
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