Injury to the adult mammalian spinal cord leads to permanent loss of controlled neurological function. Endogenous repair mechanisms fail to reestablish functional synoptic connections. Moreover, neurological outcome usually gets worse in time, due to neurodestructive processes inherent to the adult spinal cord. Surgical repair strategies need to focus on replacing damaged/lost nervous tissue, promoting axonal regeneration and reestablishing functional synaptic contacts. This review will discuss the current understanding of the potential beneficial role of Schwann cells, neurotrophic factors, biodegradable polymers or combinations thereof in spinal cord injury. Replacement, of injured spinal tissue with a Schwann cell graft promotes axonal regeneration and myelination. Neurotrophic factors initiate and/or enhance events that are crucial for functional recovery, such as cell survival and axonal regeneration. Biodegradable polymers can be used as a scaffold for cell implantation and/or as a drug delivery vehicle. The complex nature of spinal cord injury demands a combinatorial restorative approach. For the future, the challenge will be to combine individual growth-promoting properties such that neurological recovery in spinal cord injured humans can be achieved.
Biomedical Reviews 1999; 10: 75-88.
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