Outcome Prediction in Spinal Cord Injury: Myth or Reality.
Sharif Salman,Jazaib Ali Muhammad Yassar
World neurosurgery
OBJECTIVE:To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. METHODS:PubMed and Google Scholar search on experimental and clinical studies looking at the effect of various prognostic factors in tSCI. RESULTS:A total of 76 articles were selected and retrieved. As per various systematic reviews and prospective studies, the initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. There is level III evidence that keeping mean arterial pressure (MAP) >85 for 7 days in patients with spinal cord injury improves neurologic outcome. T2-weighted magnetic resonance imaging can rapidly screen patients with a cervical injury (class 2 evidence) and has significant predictive value (class 3 evidence). The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by ≥1 American Spinal Injury Association grade. Biomarkers in the cerebrospinal fluid seem to correspond significantly to the outcome of the neurologic injury. CONCLUSIONS:Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
10.1016/j.wneu.2020.05.043
Microglia and macrophages promote corralling, wound compaction and recovery after spinal cord injury via Plexin-B2.
Nature neuroscience
Tissue repair after spinal cord injury requires the mobilization of immune and glial cells to form a protective barrier that seals the wound and facilitates debris clearing, inflammatory containment and matrix compaction. This process involves corralling, wherein phagocytic immune cells become confined to the necrotic core, which is surrounded by an astrocytic border. Here we elucidate a temporally distinct gene signature in injury-activated microglia and macrophages (IAMs) that engages axon guidance pathways. Plexin-B2 is upregulated in IAMs and is required for motor sensory recovery after spinal cord injury. Plexin-B2 deletion in myeloid cells impairs corralling, leading to diffuse tissue damage, inflammatory spillover and hampered axon regeneration. Corralling begins early and requires Plexin-B2 in both microglia and macrophages. Mechanistically, Plexin-B2 promotes microglia motility, steers IAMs away from colliding cells and facilitates matrix compaction. Our data therefore establish Plexin-B2 as an important link that integrates biochemical cues and physical interactions of IAMs with the injury microenvironment during wound healing.
10.1038/s41593-020-0597-7