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How 'Perfect' Care Saved an Athlete

Back on His Feet

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Some of the more intriguing research is on what are known as Schwann cells. These cells normally wrap around the individual nerve fibers of peripheral nerves that go out to innervate organs and muscles. They can regenerate but are not found in the spinal cord. Scientists are now experimenting with ways to place Schwann cells in damaged spinal cords so they might form a "bridge" over the injured site, possibly allowing the nerve fibers (long finger-like projections from nerve cells in the brain) to grow past the point of injury.

"There is a lot of promise there, but we are not doing it in people yet," Kleitman says. "This has to be done very carefully in the lab, to the point that we know we're ready to go to [human] use of it. We're discovering what our tools are, and trying as quickly as we can to bring it to clinical reality."

Most dramatic in the last decade has been the decreasing number of people suffering complete paralysis, and the parallel increase in those with "incomplete" injuries (resulting in some, but not all, loss of function). That shift, Kleitman says, in part reflects new thinking about how newly injured people should be treated.

 

"In 1980, people believed that the brain and spine were hopeless if injured," she says. "Since the early 1990s, the thinking has gone from, 'We can't do anything, so let's wait,' to 'If we stop the chain of injury, now they will do better.' Something we're doing is helping people get some [function] back."

What doctors have learned is that it's critical to immobilize the neck and reduce inflammation after an accident. The spinal cord -- a band of soft tissue running down the back, from the brain to above the buttocks, and about as thick as a thumb -- houses a network of nerve fibers that relays messages to and from the brain and peripheral structures. Protecting the cord are bones called vertebrae. A spinal cord injury occurs when these bones shift and crush the cord, damaging nerve fibers, or fracture and pierce the cord like shrapnel. The higher the injury (closer to the head), the more likely there may be loss of function. Immobilizing the neck at least ensures that an injury in that region -- which could result in quadriplegia -- won't get worse.

Once the neck is stabilized, the next step is to reduce inflammation. While inflammation is a normal part of the healing of tissues, unfortunately when it comes to the spinal cord, swelling does more initial damage than good, distorting the delicate and highly organized nerve tissue even further. In the early 1990s, doctors began using large doses of steroids to reduce such inflammation. Today, steroids are considered the standard of care.

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