Spinal Cord Injury

The spinal cord is the long tube of nerves extending from the brain down to the level of the lower back. It is basically the wires our brains use to control our bodies. Spinal cord injuries (SCIs) usually occur following traumas, for example, due to motor vehicle crashes or recreational activities in younger people; however, they could also occur due to falls in elderly individuals (1).

These injuries mostly occur when parts of the vertebrae surrounding the cord are fractured or dislocated. This causes direct bruising or tearing within the spinal cord – and the connection is either partially or totally severed. Spinal injuries usually cause significant physical and psychological impairment that could lead to permanent functional disability and a reduction of the quality of life of affected individuals (2).

The degree of neurological impairment due to SCI is usually determined 72 hours following the insult. Patients reach most of their healing capacity by 3 months, and any improvement usually plateaus by 9-12 months (2).

Sequelae or permanent consequences of SCI usually depend on the level of cord injury; where it usually follows the rule “the higher the injury, the worse the outcome”.They also depend on whether the cord was injured totally or partially; and if partially, then which neurological tracts were injured (ex. sensory versus motor versus both). Injuries to the spinal cord can present with a diversity of symptoms, and people with similar injuries could recover differently depending on many factors. However some of the possible long-term consequences of SCI include:

• Loss of body sensation below the level of injury: The side affected depends on the type of sensation (ex. temperature versus positional sensation) as well as degree and level of injury.
• Neuropathic pain: Some people might not totally lose sensation of their bodies; but might experience chronic pain or numbness/tingling sensations. They might also perceive normal sensations abnormally, or feel pain from as little as a light touch.
• Loss of voluntary muscle movements: Depending on the level of the injury this might manifest as paraplegia (loss of lower body movement) or quadriplegia (loss of control over all four limbs).
• Muscle weakness: This is the less severe form of loss of motor function.
• Muscle spasticity: This might exacerbate the present neuropathic pain.
• Bowel and/or bladder dysfunction: People with SCI might develop difficulty in controlling their bowel or bladder movements.
• Breathing problems: In case of higher injuries (i.e. cervical or thoracic injuries)

Current treatments offered for SCI are symptomatic and solely aim to prevent further damage of the spinal cord due to the encountered trauma. For example, acute management of SCI involves:

• Spinal cord immobilization: This is an important initial step in management since it can prevent any further spinal cord injury for example due to vertebral fracture fragments. Immobilization can be done through using neck collars for the cervical spine and a spinal board for the rest of the back.
• Surgical management: Surgical decompression early on after the injury – especially within 72 hours of injury - might also prevent further nerve damage due to vertebral fracture or herniation, or due to the trauma-induced inflammation surrounding the spinal cord. The vertebral column is repaired, and any spinal cord compression is removed (3, 4).
• Corticosteroids: Some studies have also report benefits of using steroids in improving functioning if used early on within 8 hours of injury – though its role is controversial due to possible risk of infections during such a vulnerable period (4).
• Rehabilitation programs: These programs include early psychological support, physiotherapy, dietary support, occupational therapy, etc. All of these aim to improve functionality and provide patients with the best possible outcomes out of their present condition (5).

Despite there being constant advancements in diagnostic techniques for SCI to allow for faster interventions and better outcomes of cord injuries, and in developing better rehabilitation programs to improve survival and the quality-of-life of SCI patients; treatment itself has remained the same – with most current modalities focusing on preventing further damage to the nerves and stabilizing the patients’ conditions rather than restoring what has been damaged (2, 6).

However, we will now discuss how stem cell therapy has been emerging as a new hope for patients with SCI due to its promising regenerative abilities.

There are many types of stem cells to use in different conditions including embryonic stem cells, mesenchymal stem cells, hematopoietic stem cells, neural stem cells, as well as many other sources.

However, the most widely tested type in SCI, that has shown clinical benefit, is the mesenchymal origin. And even within the mesenchymal stem cell line, there are multiple sources including the bone marrow, the umbilical cord, and the adipose/fat tissue; with the cell lines with proven clinical benefits on patients with SCI only being the bone marrow and umbilical cord samples (7, 9).

At Beike Biotechnology, we use umbilical cord stem cells - umbilical cord-related mesenchymal samples donated from healthy mothers after a normal birth.

There has been lots of variation in the time used in clinical trials for stem cell transplantation after SCI; however they have all reached one consensus that stem cell transplantation should be done as early as possible to prevent further nerve damage due to inflammation and to allow optimum recovery of the injured nerves.

Optimum timing of 1-2 weeks after the injury has been suggested to provide the best results (7, 9); though multiple trials have administered stem cells after that time window with positive benefits being reported – with even some showing benefits in people with chronic SCI (> 1 year).

Given the impracticality of this time window following such a significant injury, which could be associated with other non-neurological complications, we would usually suggest an optimum time window of around three months following the injury – as used by most clinical trials reporting clinical benefit (8, 10).

Despite our recommendations – supported by clinical data – and our best efforts to provide the optimum medical service, we still need to advise that clinical benefit is not 100% guaranteed.

No treatment is without complications, and stem cell therapy for spinal cord injury is the same. However, despite its novelty, stem cell therapy has limited side effects if used properly, with comparable side effects to those experienced with regular blood transfusion or foreign organ transplantation (ex. allergic reactions, cell rejection, or fever). Other side effects that have been reported through data analysis include pain, muscle spasms, and some gastrointestinal disturbance. However, most clinical trials report milder side effects that can be managed and rarely lead to premature treatment cessation (11).

When it comes to response to treatment, we will hereby summarize different factors that might affect your loved one’s response to stem cell therapy, and how we at Beike Biotechnology address each factor to ensure that we provide you with the highest efficacy using the safest procedure possible.

• Dose/Number of stem cells: The higher the dose of stem cells – within limits of course – the better the response. At Beike Biotechnology, we administer an optimum dose of around 120-400 Million Cells (depending on the child’s weight).
• Route/Method of administration: Studies have shown that intrathecal injection (through lumbar puncture directly within the brain’s CSF) provides a better response than the traditional intravenous route (which causes stem cells to go to other organs than the brain before reaching the brain). At Beike Technology, we use both intravenous and intrathecal routes concomitantly in order to obtain maximal efficacy; while ensuring the least possible side effects or toxicity.
• Timing of treatment: As previously mentioned, the earlier the stem cell therapy, the better the benefit. We recommend therapy within the first three months – i.e. before the end of the tissue recovery process.
• Type of Stem Cells Used: As previously mentioned, umbilical cord-based mesenchymal stem cells, which we use at Beike Technology, have better-proven efficacy in SCI compared to other types of stem cells.
• Follow-up Time: Significant benefits from stem cell therapy begin appearing around three months after stem cell therapy, and most people reach their full potential around 6-12 months after treatment. At Beike Technology, even after discharge, we provide you with a full follow-up program beginning as early as one month and up to one year after transplantation. You have complete access to our professional team even after you leave our center.