CHAPTER 9
REGENERATION OF THE SPINAL CORD
The problem of regeneration of the spinal cord following transection in man and animals
has for many years been the subject of intensive clinical and experimental research
(Miiller, 1864-65; Caporoso, 1889; Harte & Stewart, 1902; Fowler, 1905; Marinesco &
Minea, 1906; Alien, 1911,1914; Cadwalader, 1920; Cajal, 1928; Minea, 1928; Freeman,
1952, 1954; Windle, 1955; Hamburger, 1955; Babbini, 1956; Tarlow, 1957; Street,
1967; Campbell, 1967 and others). Windle's book on 'Regeneration in the Central
Nervous System', in particular, gives a comprehensive review of the experimental work
in animals. From these experiments, it would appear that anatomical regeneration and
functional recovery were found in amphibia, reptiles and fish. However, this problem
is still unsolved in species of higher phylogenetic scale such as mammals, including man.
In view of the histological findings, it is not denied that regenerating nerve fibres may
penetrate the glial and fibrous scar barriers under favourable conditions, but
functional recovery through regeneration of the severed spinal cord is still unproven.
Moreover, animal experiments producing traumatic lesions of the exposed spinal cord
by varying pressures of weight in relation to the duration of pressure cannot be accepted
as proof of the mechanism and pathology of spinal cord lesions due to fractures and frac–
ture-dislocations of the spine in man. The fact that spinal animals, such as cats and
dogs, are able to stand and to learn to walk is not the result of re-innervation of the
paralysed muscles but is due to combined action of static and kinetic reflexes elicited
below the level of the transection and the compensatory function of back muscles which
have their innervation in segments above the transection but have their anatomical
attachment below the transection, thus forming a connection between the paralysed
part of the body with the normal ones. As pointed out before, in the spinal man it is in
particular trapezius and latissimus dorsi and in lower lesions also the abdominal muscles
which are responsible for the recovery of the upright position of the body following
transection of the cord.
In 1902, Harte & Stewart reported about recovery of motor and sensory function
as well as function of bladder and bowels in a female patient with transection of the cord
following gunshot injury in whom these surgeons had performed a suture of the cord.
This patient was examined 18 years later by Dr Cadwalader (1920) who, however,
found a complete paraplegia and considered the previous result of the examination by
these authors as a mistake. Other cases of suture of the spinal cord following transection
were recorded by Fowler (1905); Babbini (1956); Thomeret (1960) and Street (1967), but
no functional recovery occurred over a period of 6 to u years. In three cases of complete
transverse lesions described by Street (1967), one of the thoracic and two of the distal
spinal cord, a resection of the damaged vertebra and resection of the damaged segment
of the cord was carried out in operations lasting 6 and 9 hours respectively. The unstable
spine was fixed in one case by metal clamps, in the two others by wiring and screws.
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