Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma

Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma

1st Edition - February 17, 2022

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  • Editors: Michael Fehlings, Brian Kwon, Alexander Vaccaro, F. Cumhur Oner
  • Hardcover ISBN: 9780128198353
  • eBook ISBN: 9780128198360

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Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma provides readers with a comprehensive overview on the most up-to-date strategies to repair and regenerate the injured spinal cord following SCI and spine trauma. With contributions by international authors, chapters put regenerative approaches in context, allowing the reader to understand the challenges and future directions of regenerative therapies. Recent clinical trial advancements are thoroughly discussed, with the impact of trial findings addressed. Additionally, major ongoing clinical trials are included with thoughts from experts in the field. Recent clinical practice guidelines for the management of traumatic spinal cord injury are featured throughout. These guidelines are quickly being adopted as the standard of care worldwide, and the comprehensive information found within this book will place these recommendations in context with current knowledge surrounding spinal cord injury and spine trauma.

Key Features

  • Contains contributions by international authors
  • Covers recent clinical trial advancements and findings and updates on ongoing trials
  • Presents an overview of clinical practice guidelines for the management of traumatic spinal cord injury featured
  • Provides the reader with insights regarding the translation of research from bench to bedside and the skills needed to understand the translational pathway using real-life examples


Clinical Spine Fellows; Residents; Neurosurgeons; Clinical and Basic Researchers; Orthopaedic Surgeons; Critical Care Specialists; Medical Students; Rehabilitation Specialists

Table of Contents

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • Dedication
  • List of contributors
  • Editor bios
  • The sine qua non encyclopedia for spinal cord neurotrauma, spine trauma, and neurorehabilitation
  • Preface
  • Acknowledgments
  • Introduction
  • Chapter 1. Anatomy
  • Spinal column
  • Spinal nerves
  • Gray matter: nuclei and rexed lamina
  • White matter tracts
  • Vascular supply
  • Autonomic nervous system
  • Conclusion
  • Chapter 2. Epidemiology
  • Overview
  • History
  • Pediatrics
  • Resources
  • Prevalence
  • Incidence
  • Costs
  • Clinical
  • Etiology
  • Gender and age
  • Organized systems of care
  • Rehospitalizations
  • Neurological recovery
  • Survival
  • Chapter 3. Classification systems: spine trauma
  • Introduction
  • Cervical spine trauma classification systems
  • Upper cervical spine (occiput to C2)
  • Thoracolumbar classification systems
  • Sacral classification systems
  • Summary
  • Chapter 4. Classification systems: SCI
  • Introduction
  • Classification systems
  • Summary
  • Chapter 5. Outcome measures
  • Introduction
  • Imaging outcomes
  • Clinically determined outcome measures
  • Electrophysiological outcomes
  • Patient-reported outcome measures
  • Conclusions
  • Chapter 6. Imaging: spine trauma
  • Introduction
  • Cervical spine imaging indications
  • Patients who warrant imaging
  • Plain radiography (X-ray)
  • Computed tomography
  • Magnetic resonance imaging for the injured spinal column
  • Cervical spine clearance
  • Magnetic resonance imaging for spinal cord injury
  • Noteworthy cases
  • Imaging evaluation of vertebral artery injury
  • Summary
  • Chapter 7. Advanced imaging for spinal cord injury
  • Introduction
  • Conventional magnetic resonance imaging
  • Quantitative magnetic resonance imaging
  • Clinical applications
  • Conclusion and future directions
  • Chapter 8. Intraoperative imaging and image guidance
  • Evolution of computer-assisted navigation
  • Registration, imaging, and actuation techniques in spinal computer-assisted navigation
  • Intraoperative ultrasound
  • Chapter 9. Upper cervical spine and spinal cord injuries
  • Diagnostic considerations
  • Anatomy and injury classification
  • Upper cervical spine injury
  • Spinal cord injury in upper cervical spine injury
  • Prognosis after upper cervical spinal cord injury
  • Management of upper cervical spinal cord injury
  • Conclusion
  • Chapter 10. Spine trauma management issues: C-spine
  • Preoperative management
  • Operative management
  • Future considerations
  • Chapter 11. Spine trauma management issues: thoracic and lumbar
  • Introduction
  • Clinical evaluation
  • General management considerations
  • Specific management considerations by fracture subtype
  • Special considerations
  • Conclusion
  • Chapter 12. Spine trauma: sacral fractures
  • Introduction
  • Anatomy
  • Epidemiology
  • Classification
  • Evaluation
  • Treatment
  • Complications
  • Special considerations
  • Outcomes
  • Summary
  • Chapter 13. Spine trauma management issues: polytrauma
  • Take home points
  • Introduction
  • Conflicting priorities
  • Spine clearance
  • Primary versus secondary spinal cord injury in the setting of polytrauma
  • Cord perfusion and coagulopathy
  • Timing of fixation
  • Case examples
  • Chapter 14. Spine trauma in the elderly – management issues and treatment goals
  • Pathophysiology
  • Traumatic spinal cord injury
  • Central cord syndrome
  • Medical considerations in the geriatric spinal cord injured patient
  • Multimodality analgesia regimen
  • Cost-effectiveness of surgery in SCI
  • Vertebral compression fractures
  • Diffuse idiopathic skeletal hyperostosis
  • Conclusions
  • Chapter 15. Spine Trauma: areas of controversy and Emerging Concepts
  • Introduction
  • Management of AOSpine A3/A4 fractures: operative versus nonoperative
  • MIS versus open surgery for fractures without deformity
  • Operative management of type 2 odontoid fractures in the elderly
  • Timing of surgery for central cord syndrome
  • Role of MRI in decision-making for spine fractures
  • Conclusion
  • Chapter 16. Traumatic central cord injury
  • Introduction
  • Diagnosis and definition
  • Epidemiology
  • Pathophysiology
  • Clinical course
  • Management
  • Conclusion
  • Chapter 17. Management and pathophysiology
  • Epidemiology
  • Clinical management of spinal cord injury—standard of care in North America
  • Pathophysiology of spinal cord injury
  • Chapter 18. SCI management: role and timing of surgical intervention
  • Introduction
  • Natural history
  • The nature of surgical decompression for spinal cord injury
  • Timing of surgical decompression in cervical spinal cord injury
  • Timing of decompression in the “central cord” pattern of cervical incomplete tetraplegia
  • Timing of decompression in thoracic and thoracolumbar spinal cord injury
  • Timing in cauda equina injury
  • Current guidelines
  • Knowledge gaps surgical timing and recommendation for future research
  • Chapter 19. Intensive care and drugs after spinal cord injury
  • Introduction
  • Initial management
  • Timing of surgical decompression
  • Hemodynamic targets after SCI
  • Spinal cord perfusion pressure monitoring
  • Pharmacologic management of SCI
  • Extraspinal complications of SCI
  • Chapter 20. SCI management: rehabilitation
  • Introduction
  • Overview of the rehabilitation principles
  • Restoration of motor and sensory function
  • Minimizing secondary health conditions
  • Knowledge gaps and research opportunities
  • Chapter 21. Economic impact of traumatic spinal cord injury
  • Introduction
  • Economic burden of diseases
  • Current knowledge on cost-effective opportunities
  • Knowledge gaps and research opportunities
  • Chapter 22. Complications and adverse events following traumatic spinal cord injury
  • Introduction
  • Incidence and prevalence of complications in tSCI
  • Spectrum of complications in traumatic spinal cord injury
  • Impact of complications on neurological and functional recoveries
  • Mortality following traumatic spinal cord injury
  • The role of prediction models in evaluating patients' risk for complications
  • Conclusion
  • Chapter 23. Neurochemical biomarkers of acute spinal cord injury
  • Introduction
  • Promising neurochemical biomarkers of acute SCI
  • Chapter 24. Clinical trials: pharmacological approaches to enhance neural repair and regeneration after spinal cord injury
  • Introduction
  • Completed clinical trials
  • Drugs under active clinical investigation
  • Drugs entering clinical trials
  • Conclusion
  • Chapter 25. Clinical trials: cellular regenerative approaches
  • Introduction
  • Conclusion
  • Chapter 26. Clinical trials: noncellular regenerative approaches
  • Introduction
  • Conclusion
  • Chapter 27. Clinical trials: rehabilitation approaches
  • Background
  • Rehabilitative approaches to improve function after SCI
  • Conclusions
  • Chapter 28. Neuroprotective strategies: translational perspectives
  • Introduction
  • Excitotoxicity
  • Immunological modulation
  • Blood–spinal cord barrier maintenance
  • Other
  • Combinatorial strategies
  • Chapter 29. Translational perspective: neuroregenerative strategies and therapeutics for traumatic spinal cord injury
  • Introduction
  • Biologic therapeutics
  • Extrinsic determinants of neuronal regeneration
  • Intrinsic determinants of neuronal regeneration: the conditioning lesion paradigm
  • Cellular and acellular (biomaterial) transplant interventions
  • Summary
  • Conclusions
  • Chapter 30. Emerging concepts in the clinical management of SCI for the future
  • Introduction
  • Time is spine
  • Measures of spinal cord physiology
  • Integration of imaging data into predictive and prognostic models
  • Minimally invasive treatment modalities
  • Redefining clinical heterogeneity
  • Aging and frailty
  • A personalized approach to SCI management
  • Regenerative medicine
  • Interrogating neural circuitry to understand disease states
  • Application of brain–computer interfaces
  • Conclusion
  • Chapter 31. Translational research in spinal cord injury – What is in the future?
  • Introduction
  • Epidemiologic changes
  • Clinical considerations
  • Personalized approaches
  • Future perspectives in neuromodulation
  • Future perspectives related to artificial intelligence
  • Conclusion
  • Index

Product details

  • No. of pages: 644
  • Language: English
  • Copyright: © Academic Press 2022
  • Published: February 17, 2022
  • Imprint: Academic Press
  • Hardcover ISBN: 9780128198353
  • eBook ISBN: 9780128198360

About the Editors

Michael Fehlings

Dr. Fehlings is the Vice Chair Research for the Department of Surgery at the University of Toronto and Head of the Spinal Program at Toronto Western Hospital, University Health Network. Dr. Fehlings is a Professor of Neurosurgery at the University of Toronto, holds the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration, is a Scientist at the McEwen Centre for Regenerative Medicine and a McLaughlin Scholar in Molecular Medicine. In the fall of 2008, Dr. Fehlings was appointed the inaugural Director of the University of Toronto Neuroscience Program (which he held until June 2012) and is currently Co-Director of the University of Toronto Spine Program. Dr. Fehlings combines an active clinical practice in complex spinal surgery with a translationally oriented research program focused on discovering novel treatments to improve functional outcomes following spinal cord injury (SCI). He has published over 850 peer-reviewed articles (h-index 87) chiefly in the area of central nervous system injury and complex spinal surgery. His seminal 1991 paper, cited over 1400 times, outlined the severe and lasting consequences of SCI due to a cascade of secondary injury mechanisms following the initial trauma. His research on secondary injury mechanisms ultimately led to the commencement of the multicenter, international Surgical Timing in Acute Spinal Cord Injury Study (STASCIS), aimed at establishing the need for early surgical decompression to prevent the negative effects of the secondary injury cascade. The results from this study, led by Dr. Fehlings and published in 2012, demonstrated the critical importance of early surgical decompression (<24 hours) to improve functional and neurological outcomes, and reduce secondary complications in individuals with SCI. His work examining the use of regenerative approaches including neural stem cells to repair the injured nervous system has led to numerous international awards and has helped lead the field toward clinical translation in this area. In 2017, the initiative to create Clinical Practice Guidelines for the management of degenerative cervical myelopathy and acute traumatic SCI – a multi-disciplinary international effort led by Dr. Fehlings - was published in the Global Spine Journal. Most recently, Dr. Fehlings’ work demonstrating that midcervical excitatory interneurons are essential for the maintenance of breathing in non-traumatic cervical SCI and critical for promoting respiratory recovery after traumatic SCI was published in Nature. Dr. Michael Fehlings has received numerous prestigious awards including the Gold Medal in Surgery from the Royal College of Physicians and Surgeons (1996), nomination to the Who’s Who list of the 1000 most influential scientists of the 21st century (2001), the Lister Award in Surgical Research (2006), the Leon Wiltse Award from the North American Spine Society for excellence in leadership and/or clinical research in spine care (2009), the Olivecrona Award (2009) -- the top award internationally for neurosurgeons and neuroscientists awarded by the Nobel Institute at the Karolinska Institute in Stockholm for his important contributions in CNS injury repair and regeneration, the Reeve-Irvine Research Medal in Spinal Cord Injury (2012), the Golden Axon Leadership Award (2012), the Mac Keith Basic Science Lectureship Award for significant contributions to the basic science of cerebral palsy and childhood onset disabilities (2012), and was the Mayfield Lecturer (2012). In 2012, Dr. Fehlings served as the 40th President of the Cervical Spine Research Society (CSRS) -- the only Canadian to do so -- and was honoured with the CSRS Presidential Medallion for outstanding leadership and contributions to cervical spine research. In 2013, Dr. Fehlings was honoured with the Queen Elizabeth II Diamond Jubilee Medal presented to him by the Honourable Stephen Harper, the H. Richard Winn Prize from the Society of Neurological Surgeons, the Jonas Salk Award for Scientific Achievements from the March of Dimes Canada and the Henry Farfan Award from the North American Spine Society. In 2014, Dr. Fehlings was elected to the Fellowship of the Royal Society of Canada and to the Canadian Academy of Health Sciences, and in 2016 won the Royal College of Physicians and Surgeons Mentor of the Year Award.

Affiliations and Expertise

Professor of Neurosurgery, Vice Chair Research, Department of Surgery, Halbert Chair in Neural Repair and Regeneration, Co-Chairman Spinal Program, University of Toronto and Head Spinal Program, Senior Scientist McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network

Brian Kwon

Dr. Kwon is a surgeon-scientist with advanced training in spine surgery and also a PhD in neuroscience. He is a Professor in the UBC Department of Orthopaedics. As an attending orthopaedic spine surgeon at Vancouver General Hospital his practice is focused on the management of adult spine trauma, spinal cord injuries, and non-traumatic conditions such as spine infection, deformity, and degeneration. As a neuroscientist and Principal Investigator at ICORD, Dr. Kwon runs an active basic/translational research laboratory. Dr. Kwon is currently also serving as the Associate Director, Clinical Research, for ICORD, and is the Associate Scientific Director of the Rick Hansen Institute.

Affiliations and Expertise

Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada

Alexander Vaccaro

Dr. Vaccaro has served as the president of Rothman Orthopaedics since 2014 and is the Richard H. Rothman Professor and Chairman in the Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University in Philadelphia, Pennsylvania. He was the recipient of the Leon Wiltse award given for excellence in leadership and clinical research for spine care by the North American Spine Society (NASS) and is the past President of Cervical Spine Research Society (CSRS), the American Spinal Injury Association and the Association for Collaborative Spine Research. He is currently a member of the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors. He has over 900 peer-reviewed and 200 non-peer reviewed publications. He has published over 372 book chapters and is the editor of over 63 textbooks and co-editor of OKU-Spine I and editor of OKU-8. Dr. Vaccaro also serves as Co-Director of the Regional Spinal Cord Injury Center of the Delaware Valley.

Affiliations and Expertise

Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery, Professor of Neurosurgery, Sidney Kimmel Medical Center of Thomas Jefferson University, Co-Director, Delaware Valley Spinal Cord Injury Center, President, Rothman Orthopaedics

F. Cumhur Oner

Cumhur Öner obtained in 1980 his Medical Degree in Ankara, Turkey and did his orthopaedic surgery training in Rotterdam between 1987 and 1993. Since 1993 he works as an orthopaedic spine surgeon at the University Medical Centre Utrecht. He obtained his PhD (cum laude) in 1999 from the University of Utrecht. The work for his PhD thesis focused on the diagnostic and prognostic parameters in spinal trauma patients. He is the head of the neuro-orthopaedic spine unit since 2002. Cumhur Öner has actively participated in the foundation of the international Spine Trauma Study Group and is currently member of the steering committee of the Knowledge Forum Trauma of the AOSpine International. He has been involved in clinical spine research as well as the bone and intervertebral disc RM program in the UMC Utrecht. He was the president of the Dutch Spine Society between 2007-2011.

Affiliations and Expertise

University Medical Centre Utrecht, Utrecht, The Netherlands

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