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Michael G. Fehlings and Allyson Tighe

development of new treatments for SCI could substantially reduce the physical, psychological, and economic impact of this devastating condition. The current treatments for SCI are limited. Patients generally undergo decompressive surgery and receive extensive rehabilitative therapy. Some may receive corticosteroidsto reduce harmful inflammation at the site of injury, although this treatment remains controversial. 3 None of these interventions are spectacularly effective in the recovery of function. Rehabilitation can lead to some improvements in motor control and

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James W. Rowland, Gregory W. J. Hawryluk, Brian Kwon and Michael G. Fehlings

nimodipine) have been investigated in large, prospective, randomized, controlled clinical trials, all have failed to demonstrate convincing neurological benefit, despite the promise that these agents demonstrated in preclinical animal studies of SCI. The aim of this review is to provide an overview of the current state-of-the-art of SCI pathophysiology while highlighting the important aspects for which therapeutic interventions are being developed. The latter half of the review will discuss recent preclinical advances in SCI therapies, focusing mainly on cell

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Michael G. Fehlings

. Nonetheless, it is encouraging that the patients appeared to tolerate the treatment well without evidence of neurological deterioration. Based on the Phase I trial, Proneuron is now conducting a Phase II randomized controlled trial evaluating the efficacy of incubated autologous macrophages compared with controls (no cell therapy) at six treatment sites in the US and Israel (D. Snyder, personal communication). This trial will result in a much more convincing level of evidence regarding the potential efficacy of this intriguing form of cell-based therapy. The next decade

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Michael G. Fehlings

concerns that release of CSF below a swollen, compressed cord could result in neurological deterioration. 3 However, there are some theoretical advantages to placing a lumbar subarachnoid catheter following acute SCI: 1) there is evidence that drainage of CSF may enhance neurological recovery following ischemic cord injury in the setting of aortic surgery; 1 , 5 2) measurement of spinal CSF pressures could allow targeted hypertensive therapy directed at maintaining spinal cord perfusion pressures (SCPPs) above a critical threshold; and 3) in the future, measurement of

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Editorial

The safety of percutaneous vertebroplasty and kyphoplasty

Michael G. Fehlings

Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty . BMC Musculoskelet Disord 8 : 126 , 2007 4 Klazen C , Verhaar H , Lampmann L , Juttmann J , Blonk M , Jansen F , : VERTOS II: percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objectives and design of a multicenter randomized controlled trial . Trials 8 : 33 , 2007 5 Taylor RS , Taylor RJ , Fritzell P : Balloon kyphoplasty and

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Steven Casha and Michael G. Fehlings

standard and modified techniques. Spine 19 : 660 – 663 , 1994 Emery SE, Bolesta MJ, Banks MA, et al: Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine 19: 660–663, 1994 8. Helm GA , Alden TD , Sheehan JP , et al : Bone morphogenetic proteins and bone morphogenetic protein gene therapy in neurological surgery: a review. Neurosurgery 46 : 1213 – 1222 , 2000 Helm GA, Alden TD, Sheehan JP, et al: Bone morphogenetic proteins and bone morphogenetic protein gene

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Julio C. Furlan and Michael G. Fehlings

risk of recurrent DVT, postthrombotic syndrome, and development of PE, intravenous or subcutaneous heparin therapy should be immediately initiated and, subsequently, replaced by treatment with oral warfarin for a period of time ranging from 6 weeks to 6 months. 46 , 57 Given that the use of anticoagulation treatment involves a relatively significant risk of hemorrhage, clinicians need to weigh the potential benefits and risks for each patient in the process of decision making. 44 , 67 When acute PE is diagnosed, the patient should be treated with parenteral

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Henry Ahn and Michael G. Fehlings

decompression along with antibiotic therapy is warranted if the patient has neurological deficits, if the microorganism is not known, or if the infection is not responding to antibiotic therapy. Epidural abscesses caused by a known organism in patients without deficits can potentially be treated medically. 73 Long-Term Care of Patients with POSCIs The long-term prognosis for patients with POSCIs is variable and can depend on the patient's age, extent of injury, and whether the injury is complete or incomplete. However, based on the cervical myelopathy literature

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Toshitaka Seki and Michael G. Fehlings

procedures to release adhesions (detethering procedures) and drain the cysts (commonly involving syringo-subarachnoid or syringopleural shunts); however, these treatments are suboptimal, and patients often retain lifelong disabilities. 6 , 60 Additionally, the cyst cavities may serve as a barrier to endogenous reparative processes in the injured spinal cord and present a major obstacle to the successful clinical translation of regenerative strategies such as cell-based therapies. Pathophysiological Characteristics of PTS The pathological features of PTS are

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W. Bradley Jacobs and Michael G. Fehlings

, Luoto S , Konttinen YT : Traumatic spinal cord injury as a complication to ankylosing spondylitis. An extended report . Clin Exp Rheumatol 20 : 66 – 68 , 2002 2 Anonymous : Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries . Neurosurgery 50 : 3 Suppl S73 – S80 , 2002 3 Anonymous : Management of acute spinal cord injuries in an intensive care unit or other monitored setting . Neurosurgery 50 : 3 Suppl S51 – S57 , 2002 4 Anonymous : Pharmacological therapy after acute cervical spinal cord injury