Cell transplantation in paraplegic patients: the importance of properly assessing the spinal cord morphology.

Introduction: Cell transplantation in paraplegic patients is beginning, but scarce attention is paid to the morphology of lesions.

Material And Methods: We studied using magnetic resonance imaging (MRI) the morphology of the injured spinal cord in 200 patients with chronic and complete paraplegia after spinal cord injury (SCI) at the thoracic level.

Results: When it was possible to undertake a correct study of the lesion, approximately 35% of patients had images showing spinal cord transection or showed fine tracts of tissue that connected both edges of a virtually transected spinal cord. Approximately 30% of patients had significant kyphosis with chronic spinal cord compression, and approximately 5% of cases had extensive spinal cord atrophy. In only approximately 30% of the patients, MRI revealed a centromedullary cavity, which was generally limited to the level of the vertebral fracture, and failed to show any apparent spinal cord transection.

Conclusions: Humans suffering from chronically established paraplegia show a great variability of lesions, which differs from the standardized images of SCI obtained in animal models. When we design clinical trials, our goal should be to achieve a correct selection of patients, and the morphology of the spinal cord must be one of the main factors to consider.