Comparing Stem Cell Therapy and Surgery for Spinal Cord Injuries

This report presents a systematic review comparing the effectiveness of spinal decompression surgery and stem cell therapy in treating spinal cord injuries (SCIs). The study examines the causes of SCIs, which often result from physical trauma leading to compression or stretch injuries. Spinal decompression surgery involves creating space for the spinal cord, while stem cell therapy aims to replace damaged cells and reconnect neural circuits. The review analyzes the epidemiology of SCIs, search strategies, inclusion/exclusion criteria, and findings from six articles. Results indicate that stem cell transplantation aided limb recovery in SCI mice models, and early decompression surgery showed improved outcomes. The conclusion suggests that stem cell therapy may be the recommended procedure, particularly due to potential drawbacks of decompression surgery such as bone graft migration and persistent pain. References to several research papers support the findings.

Comparing use of stem cell and spinal
compression surgery for treating spinal
cord injuries
Name of the Student
Student ID-

Spinal cord injuries
• These refer to damages to the
spinal cord that bring about
temporary or permanent changes
in its function.
• Such injuries are found to result
in loss of sensation, loss of
muscular or autonomic function
of body parts (McDonald, Becker
and Huettner 2013).
• The injuries can be either
complete or incomplete
depending on loss of sensation
(van den Brand et al. 2012).

Causes of spinal cord
injuries
• Physical trauma
• Hyperflexion force
• Hyperextension force
• Lateral stress
• Rotation
• Compression (Chen et al.
2013)
• Distraction
Most SCIs result in
compression, contusion or
stretch injuries.

Treatment- Spinal decompression
surgery
• Stenosis of narrowing of spinal
canal creates numbness, chronic
pain and muscle weakness
• Decompression surgery involves
removal of the nerves and spinal
cord for creating more space for
free movement (Minamide et al.
2013).
• Decompression requires 1-3
days of hospitalization
• Recovery time ranges from 4-6
weeks

Drawbacks of decompression
surgery
• Deep vein thrombosis
• Hardware fracture
• Failure of the vertebrae to fuse
(Mobbs et al. 2014)
• Bone graft migration
• Persistent pain
• Nerve damage
• Transitional syndrome

Treatment- Stem cell
therapy
• Based on the objective of
replacing lost spinal cells and
allowing reconnection in the
broken neural circuit
• It helps in regrowing axons
(Lu et al. 2012)
• Neural stem cells, embryonic
stem cells, mesenchymal
stem cells, schwann cells, and
induced pluripotent stem cells
are used for the purpose
(Nakamura and Okano 2013).

Disadvantages of stem cell therapy
• Use of stem cells involves
destruction of blastocytes formed
from invitro fertilisation.
• Adult stem cells would originate only
a particular type of cell
• Embryonic stem cells will not be from
similar human body and can get
rejected

Aim of the Systematic review
To compare the effectiveness of spinal
decompression surgery and stem cell
therapy for treating spinal cord injuries
Epidemiology
•The worldwide numbers of spinal cord
injury ranges from 10.4-83 individuals per
million, per year.
•More than 39 people per million in North
America are found to suffer from SCI each
year (Lee et al. 2014).
•US prevalence rates are approximately 40
cases per million every year (Ma, Chan and

Search strategy
Database
engine
Search
terms
Articles
found
PubMed ‘spinal
decompressio
n surgery’
AND ‘spinal
cord injury’
148
PubMed ‘stem cell
therapy’ AND
‘spinal cord
injury’
26

Inclusion criteria Exclusion criteria
•Trials on human or
animal models
•Spinal cord injuries
should be the main focus
of the article
•Human trials must be
done on adults
•Must be published in
English
•Must be published not
prior to 2011
•Accepted manuscripts
will be considered
•Review based articles
•Studies conducted on
patients aged less than
18 years
•Articles published in
foreign language
•Articles published before
2011
•Abstracts
Inclusion and Exclusion criteria

Results of6 articles
Fujimoto et al. 2012 Transplanted hiPS‐lt‐NES cell‐
derived neurons restored
motor function in mouse
model of spinal cord injury.
Stem cells helped in
reconstruction of the
corticospinal tract
Quertainmont et al. 2012 Mesenchymal stem cell
grafting showed NGF
expression increase, and
vascularisation of injured
spinal cord tissue
Fehlings et al. 2012 Immediate decompression
surgery after SCI showed
improved neurologic
outcomes (2 grade AIS
improvement) during follow-

…continued
Wilson et al. 2012 2 grade AIS improvement was
observed in the SCI patient
group subjected to early
decompression surgery
Hur et al. 2016 Intrathecal injection of
adipose-derived mesenchymal
cells improved ASI motor
scores in 5 patients and ASI
sensory scores in 10 patients
Furlan et al. 2016 Early spinal compression
surgery was found to be more
cost-effective upon
comparison with late spinal
compression surgery among
SCI patients.

Summary findings
Stem cell transplantation helped in
limb recovery in SCI mice model
(Fujimoto et al. 2012)
SCI mice models showed better
locomotion after stem cell grafting
(Quertainmont et al. 2012)
Better ASI grade improvement s
in early decompression surgery
(Fehlings et al. 2012)
Improved ASI grades among SCI patients
subjected to early decompression surgery
(Wilson et al. 2012)

Conclusion of the review
• Spinal decompression may fail for patients with
previous history of spinal fusion with
instrumentation.
• Decompression also has potential disadvantages
related to bone graft migration, persistent pain and
nerve damage.
• Stem cell transplantation has several advantages
such as abundant supply of mesenchymal stem cells
by umbilical cord tissues and lack of chemotherapy
drug administration for granulocyte production.
• Thus, stem cell therapy is the recommended
procedure for treating spinal cord injuries.

References
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