What are the most promising new treatments for spinal cord injuries? - David Chen, MD

For many years, the treatments for spinal cord injury were very limited, and the research was very limited in that area, because we really didn’t have a good understanding of everything that happens after the point of injury to the central nervous system, and to the spinal cord. In the last two decades, our understanding of just all the things that happen, from the nerve level, to the cellular level, about how the immune system is involved after spinal cord injury, has grown exponentially. And because of that, we now have many more ideas about different treatment strategies that might be able to help at different points in time after an injury. So for example, we know with a spinal cord injury that a natural thing that’s set off is an inflammatory reaction. Just like if you were to, in a sporting injury, twist your ankle, the natural event that happens after spraining your ankle is swelling. Swelling in the spinal cord is not a good thing. It can cause further damage to the nerve, because it puts more pressure on the spinal cord. So now, a number of investigators are looking at different treatments that can be given after an injury—perhaps 24 hours after an injury, 48 hours, 72, a week after injury— that hopefully might modulate and dampen the natural mechanisms that take place after an injury, that often times is harmful to the spinal cord. So when we look at different treatments that are currently being studied, and that may be beneficial and available in the near-term future, some of these treatments are aimed at modulating the immune system. They may be aimed at optimizing the environment within the spinal cord for the nerves to recovery themselves. There are even some treatments that are being proposed that might help these nerves that have survived the injury to re-myelinate themselves, in other words to re-grow the insulation around them that is often times damaged after a spinal cord injury, that causes the nerves not to function. And ultimately, there are even research that’s going on looking at the possibilities of either regenerating or re-growing new nerves.