Treatment – SCIR

TREATMENT

All patients will undergo active rehabilitation.

All Patients are  followed up at monthly interval . Neurological evaluation will be done at 3 monthly interval by a neurologist and will be graded according  to ASIA protocol.

Electrophysiological evaluation for recovery of MEP or SEP and MRI for changes in anatomy of cord   will be done at 6 months then after at one year.

After clinical (ASIA) and MRI staging of severity (contusion  & total disruption  with or without gap) we start with –

Immediate

Postural reduction
Hypothermia –
Maintain Blood Pressure on higher side
Maintenance of arterial oxygen levels

Followed by Decompressive surgery with fixation +\- omental transposition as early as possible.

Omentum transposition in acute setting is  indicated only in pure contusion in injuries
Omentum transposition should be deferred for at least 2-6 weeks in  patients with laceration /maceration
There are high chances of  loosing  living  swollen grey matter .
Patients should be serially evaluated and monitored for progression of odema resolution.

(these observations are derived from a the first ever clinical trial omental transposition with dr Harry Goldsmith (pioneer in omental transposition surgery  in acute sci in supported ISCI Iceland)

In subacute phase

With in 15 days to 6 months
Intraveonous/intrathecal/intrarterial Injection of autologous stem cells.
Auyervedic medicines- extract of mimosa pudica
Drugs like Minocycline
Physiotherapy And specific Rehabilitation Regimen

After 6 months

After Assessment  of type of scar (Cystic \Lacerative or Diffuse )
Duroplasty
Scar reduction
Implantation of autologous stem cells
intravenous/intraarterial/intrathecal/epidural/caudal injection of autologous stem cells
intraspinal/intralesional injection of autologous stem cells

Whole  Autologous olfactory tissue transplantation Omental transposition +\-