Strategies to promote neural repair and regeneration after spinal cord injury

Study Design. Retrospective review of current literature regarding neuroprotection and axonal regeneration therapies for acute spinal cord injury. Objectives. To provide an update for spine clinicians of the emerging therapeutic strategies for promoting neural repair and regeneration after spinal cord injury. Summary of Background Data. The neuroscientific community has generated a number of novel potential treatments for spinal injuries, some of which have entered clinical trials. Clinicians who manage spinal cord trauma are likely to encounter patients and their families who have questions or wish to be involved in these emerging treatments. Methods. Literature review, with particular focus on currently used medications that may have neuroprotective potential in spinal cord injury, and axonal regeneration strategies that are emerging in preliminary human clinical trials. Results. A number of medications such as erythropoietin and minocycline have demonstrated neuroprotective properties in animal models of spinal cord injury, and their long-established safety in humans make them appealing candidates for clinical trials. Human experience with novel neuroprotective and axonal regeneration strategies is growing around the world, and the peer-reviewed reporting of this is anxiously awaited. Conclusions. The initiation of human clinical trials for spinal cord-injured patients heralds great hope that effective therapies will be forthcoming, although a great deal remains to be learned. Clinicians must provide leadership in the epidemiologic design and rigor of these initial forays into human evaluation.