A Promising Future: Spinal Cord Injury Clinical Trials and Drug Therapy Update

Interesting innovations in medication therapies, cellular transplantation, spinal cord stimulation, and robotic devices.

Written by Michael G. Fehlings, MD, PhD, FRCSC, FACS

Research in spinal cord injury (SCI) has been especially active in the past several decades, as demonstrated by a rise in promising therapies being studied in clinical trials. This article describes SCI therapies planned or currently under study, including innovations in medication therapies, cellular transplantation, spinal cord stimulation, and robotic devices.
Medication Innovations for Spinal Cord Injury
The latest advances in drug therapies for SCI are largely categorized as neuroprotective or neuroregenerative treatments.

Neuroprotective treatments

Neuroregenerative treatments

Cellular Transplantation to Repair the Damaged Spinal Cord
Spinal cord injury causes a significant amount of tissue loss that cannot be saved by the spinal cord’s natural ability to repair itself. Innovations in cell transplantation can help replace lost cells, regulate cell function at the injury site, and improve cell regeneration.

In animal studies, cell transplantation into the damaged spinal cord was shown to promote motor function (walking, paw use, and climbing) and bladder function. A promising aspect of cell transplantation is that cells implanted 1 month after the traumatic injury were effective in animal tests.

Human trials have shown the safety and early effectiveness of cell transplantation after SCI, but larger patient sizes and longer follow-up studies are needed to understand the true safely and effectiveness of this therapy.

Spinal Cord Stimulation and Robotics Improve Outcomes After Spinal Cord Injury
In addition to drug therapies and cell transplantation, spinal cord stimulation and robotic technologies are exciting areas of SCI innovation.

Spinal cord stimulation uses a surgically implanted electrical current in the epidural space to improve functional and walking-related outcomes in patients with chronic SCI (chronic SCI refers to having SCI for more than 1 year).

Robotics are also playing a bigger role in helping people with SCI regain function and independence after their injury. In 2014, the U.S. Food and Drug Administration (FDA) approved the first wearable robotic exoskeleton for people with paraplegia after SCI. The device fits around the legs and back, allowing people to stand, walk, turn, and climb.

As researchers continue to learn more about spinal cord injury, the hope is that the various medical advances—medications, cellular technology, spinal cord stimulation, and robotics—may be used together to improve long-term outcomes for people affected by traumatic SCI.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

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