Multimodal Treatment of Chronic Spinal Cord Injury With Human Cord Blood Stem Cell Therapy, Surgery, and Regenerative Rehabilitation: Clinical Review.

Abstract

The absence of effective treatments for traumatic spinal cord injury (SCI) generates significant adverse physical, psychological, and economic impacts at the individual and societal levels. The injured spinal cord remodels via a glial scar, cystic cavitations, and adhesions to surrounding tissue, in turn attenuating the cord's self-regenerative capacity. However, data from animal models and phase I/II human studies have yielded meaningful recovery of sensorimotor and bowel/bladder function with the use of umbilical cord blood mononuclear cells (UCB-MNCs) in chronic SCI. Removing the adhesions through laminectomy and untethering surgery facilitates intrinsic cord repair, likely through restoration of CSF and blood flow, as well as enhancing mitochondrial metabolism. Likewise, regenerative rehabilitation using intensive locomotor training independently enhances patient functional recovery after SCI. Combined, a multimodal approach to treatment of chronic SCI using UCB-MNCs, untethering surgery, and regenerative rehabilitation holds promise for improving patient outcomes. The review presents an overview of this multimodal approach to chronic SCI treatment.