Spinal Cord Injury: Promise, Progress, and Priorities

Abstract

Spinal Cord Injury: Promise, Progress, and Priorities from the National Academies' Institute of Medicine proposes a comprehensive research program to enhance neurologic and functional outcomes for people with spinal cord injury (SCI). With funding from the New York State Spinal Cord Injury Board, the Institute of Medicine impanelled a 13-member committee of SCI researchers and advocates that also solicited recommendations from other well-known SCI researchers. The book posits potential for clinical breakthroughs based on recent animal SCI research and outlines a proposal for greater study of basic SCI neurobiology and of neuroplasticity treatment options, coordinated translational trials, and strengthened infrastructure for SCI research. The book most successfully targets persons with SCI, advocates for SCI research, and policy makers. For SCI researchers and SCI clinicians, much of the material is basic review, although the overview may be useful for those new to the field. The chapter on design of clinical trials argues for a traditional “big science” approach with several Centers of Excellence and a National SCI Research Network to be established to facilitate large-scale, multicenter trials. An alternate viewpoint, that exploratory research is often most rapidly and most cost-effectively accomplished on a small scale by many individual basic science researchers and clinician-investigators, is not represented. Many potential therapeutic interventions are addressed, such as preventing secondary neurologic injury, controlling inflammation, promoting axon regrowth, using gene therapy, bridging gaps with transplantation, and restoring impulse conduction. Concerns are raised about the premature clinical use of these new therapies before safety has been fully evaluated (eg, oligodendrocyte-ensheathing glia transplants into the spinal cord of patients with paraplegia). Some areas of SCI research with therapeutic potential are minimally discussed (eg, treatment of incomplete spinal cord injury, neurotransmitters and neurotrophins and their respective receptor changes, plateau potentials, ion-channel alterations, robotics, and brain-computer interfaces). Figures are sparse. The final chapter on state-funded SCI research programs nicely summarizes this less well-known information.