Spinal Cord Injury: Progress, Promise and Priorities

Abstract

The tragic accident that left Christopher Reeves quadriplegic, his considerable efforts to cope with this utilizing all possible methods, and the publicity he generated, resulted in a much greater awareness of the problems faced by patients with spinal cord injuries, and was a powerful stimulus to research in this field. This monograph is dedicated to his memory and has been produced by an expert committee, chaired by Richard T Johnson, in collaboration with the board of Neurosciences and Behavioral Health, at the request of the New York State Spinal Cord Injuries Research Board. There are about 11 000 spinal cord injuries a year in the USA and nearly 250 000 patients living with these injuries—mostly young men in their late twenties and early thirties. The total annual cost in the USA is about US$10 billion. This puts spinal cord injury behind multiple sclerosis—but ahead of epilepsy, Parkinson's disease, Alzheimer's disease and stroke—in terms of annual cost per patient. The pathophysiology of spinal cord injury and, in particular, factors which determine its progression are discussed in detail. Little can be done to alter the instant effect of injury, except for prophylaxis. However, the hope is that there might be effective protocols for the immediate management which might reduce the risk of further damage and perhaps arrest the development of the lesion, and hence reduce the long-term disability. At present, management is largely that of the complications including pain, spasticity, bladder and bowel dysfunction, autonomic disturbance and pressure sores; all of which are discussed in separate sections. Prospects for neuronal repair and regeneration remain theoretical and experimental. Among the nine appendices are the outcome of 13 published clinical trials of methylprednisolone and an analysis of 321 published clinical trials and studies from 1998 to 2003, grouped by system or clinical problem (acute care, bladder and bowel, bone density, cardiovascular, exercise and locomotion, electrical and magnetic stimulation, imaging, psychological factors, spasticity, neurological responses, outcome measures, pain, physiological responses, respiration, syringomyelia and pressure sores). This monograph will be essential reading for all those working in the field of spinal cord injury and an invaluable reference source. It should also stimulate research granting bodies and the Government to take a greater interest in research on spinal cord injuries, which is clearly underfunded and under-resourced.