Pathophysiology of spinal cord injury and advanced therapeutic approaches

Spinal cord injuries are severe and debilitating, potentially causing permanent neurological losses. Such devastating injuries are associated with limitations in the established treatments, thus demanding some innovative avenues. One among such highly promising approaches concerning tissue-engineered repair in spinal cord injuries (SCI) is the employment of an amalgamation of cells, growth factors, and scaffolds by considering their possible application for regeneration and repair in damaged tissues. This review article covers all the complex pathophysiology associated with SCI, including acute, subacute, intermediate, and chronic phases. Traditional treatments include medications, surgery, and rehabilitation while advanced tissue engineering approaches involve hydrogels as well as electro spun nanofibers as cell scaffolds. Stem cells applied in such therapies may be derived from dental pulp stem cells, stromal cells, oral mucosa stem cells and olfactory ensheathing cells. Regeneration of the damaged area is dictated by controlling factors like neurotrophic factors, cyclic AMP, chondroitin sulphate, inflammatory cytokines etc. 3D scaffolds are recommended over 2D scaffolds. A dynamic and more effective method is provided by 4D scaffolds which may alter the structure in response to inputs. While there have been groundbreaking developments with these approaches, significant challenges exist in the translation of these laboratory investigations into efficacious therapies in the clinical setting. Further studies are thus needed to optimize the sources of cells, scaffold design, and delivery methods to attain the highest possible outcomes. The review also focuses on extracellular vesicular therapies and targeted therapies hold more promise for effective recovery.