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World J Stem Cells. Feb 26, 2021; 13(2): 168-176
Published online Feb 26, 2021. doi: 10.4252/wjsc.v13.i2.168
Review of operative considerations in spinal cord stem cell therapy
Pavan S Upadhyayula, Joel R Martin, Robert C Rennert, Joseph D Ciacci
Pavan S Upadhyayula, Joel R Martin, Robert C Rennert, Joseph D Ciacci, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA 92037, United States
Author contributions: Martin JR and Ciacci JD conceived of this manuscript; Martin JR, Upadhyayula PS and Rennert RC performed the literature review and initial data collection; Martin JR, Upadhyayula PS and Rennert RC wrote the manuscript; Martin JR, Upadhyayula PS, Rennert RC and Ciacci JD all edited and prepared the manuscript for submission.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pavan S Upadhyayula, BA, Academic Research, Department of Neurological Surgery, University of California, San Diego, 9300 Campus Point Drive, La Jolla, CA 92037, United States. psupadhy@health.ucsd.edu
Received: December 6, 2020
Peer-review started: December 6, 2020
First decision: December 31, 2020
Revised: January 18, 2021
Accepted: February 12, 2021
Article in press: February 12, 2021
Published online: February 26, 2021
Abstract

Spinal cord injury (SCI) can permanently impair motor and sensory function and has a devastating cost to patients and the United States healthcare system. Stem cell transplantation for treatment of SCI is a new technique aimed at creating biological functional recovery. Operative techniques in stem cell transplantation for SCI are varied. We review various clinical treatment paradigms, surgical techniques and technical considerations important in SCI treatment. The NCBI PubMed database was queried for “SCI” and “stem cell” with a filter placed for “clinical trials”. Thirty-nine articles resulted from the search and 29 were included and evaluated by study authors. A total of 10 articles were excluded (9 not SCI focused or transplantation focused, 1 canine model). Key considerations for stem cell transplantation include method of delivery (intravenous, intrathecal, intramedullary, or excision and engraftment), time course of treatment, number of treatments and time from injury until treatment. There are no phase III clinical trials yet, but decreased time from injury to treatment and a greater number of stem cell injections both seem to increase the chance of functional recovery.

Keywords: Stem cell, Spinal cord injury, Operative techniques, Stem cell transplantation, Intramedullary

Core Tip: Beyond the biological diversity of stem cell transplantation for spinal cord injury are the technical considerations in designing clinical treatment paradigms. The data suggest that time from injury to treatment, the duration and chronicity of treatment and the actual delivery method of cells are important considerations. This evidence seems to suggest that longer treatment paradigms soon after injury may be most beneficial.