The applied neurobiology of human spinal cord injury: a review

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Abstract
The immediate reward of neuropathology is to provide the paraplegist with an explanation for the patient's neurological symptoms. This information also assists clinical management by defining the pathology of the bony spine, cord and systemic complications. A detailed knowledge of human spinal cord injury neuropathology also sets the context for basic research. The information on which these studies are based is derived from 191 acute coroner's cases, 95 survivors of spinal cord injury collected since 1958 with the assistance of Sir George Bedbrook, 108 ‘medical’ disorders, 37 others with metastatic carcinoma and 129 normal subjects, giving a total of 560 cases. In the hyperacute material and in many who survived the injury, an important observation is the finding of continuity of CNS tissue at the level of the lesion. Of 67 patients who were ‘clinically’ complete, 50 showed some continuity across the injured segments. This anatomical finding encourages the work of restorative neurologists as it provides a basis for enhancement or modification of residual functions. In work currently supported by the Medical Research Foundation of Western Australia, a data bank of clinicopathological information has been established. This allows detailed correlations which may assist clinical management and restorative interventions. In addition the Foundation supports the anatomical investigation of the distribution and vulnerability of particular nerve fibre tracts. Nerve root regeneration is a common finding in patients who have survived their injury for more than a few months. It appears that such fibres undergo continuous reorientation in a vertical direction. With the identification of Schwann cell growth factors and their role in CNS regeneration nerve roots extending into the cord deserve close scrutiny. A complete knowledge of the developmental neurobiology of the CNS is a necessary prelude to possible future successful transplantation and regeneration. Plasticity, reflexology, information concerning growth and inhibitory factors, receptors, peptides, endocrines and neurotransmitters are integral to the problem. Genes which control growth and differentiation are now being identified and this work gives hope that basic research may lead to replacement of lost CNS tissues in the long term.