Biological and Pharmacological Enhancement of Regeneration in Chronic Spinal Cord Injury

Prospective, randomized, single-blind, comparative study.

To compare the efficacy of multiple bone marrow implantations and co-administration of citicoline to multiple bone marrow implantations alone in the treatment of chronic Spinal Cord Injury (SCI).

The study was conducted at Fathima Matha Physiotherapy and Rehabilitation Center in Kottayam, India.

Twenty-three participants with chronic traumatic SCI, classified as American Spinal Injury Association Impairment Scale (AIS) A, B, or C, were recruited and randomized into two groups. The first group (BMCT group) received multiple intrathecal implantations of autologous non-manipulated bone marrow aspirate along with oral citicoline (Cytidine Diphosphate Choline). The second group (BM group) received only multiple intrathecal bone marrow implantations. Patients were assessed at baseline and followed up every three months for 24 months.

Comprehensive evaluation upon completion of the treatment demonstrated statistically significant improvements in AIS, Spinal Cord Independence Measure (SCIM) score, Walking Index for Spinal Cord Injury (WISCI) score and modified Ashworth score in the BMCT group compared to the BM group. The BMCT group demonstrated statistically significant improvement in motor and sensory scores also. Fractional Anisotropy (FA) values of Diffusion Tensor Imaging (DTI) recorded statistically significant improvement in both the groups after treatment. The Diffusion Tensor Tractography (DTT) recorded considerable improvement only in the BMCT group.

This study observed statistically significant functional and neurological recovery in the BMCT group. The statistically significant increase in FA values recorded in both groups and the post-treatment improvements in DTT and MRI in the BMCT group are imaging evidences of spinal cord regeneration.

The online version contains supplementary material available at 10.1007/s43465-024-01328-8.