(P-BT-28) Regenerative Strategy for Consequences of Military Spinal Cord Injury: A Complex Approach Using Heterogeneous Hydrogel, Invasive Electrostimulation and Multipotent Stromal/stem Cells

Background/Case Studies: Combat-related spinal cord injury (CSCI), primarily from blast and penetrating trauma in modern warfare, frequently causes severe, permanent neurological disability. This necessitates specialized protocols encompassing diagnosis, acute management, surgical intervention, and long-term rehabilitation. Given the ongoing large-scale conflict, this issue holds particular and acute relevance in Ukraine today.

Study

Design/Methods: )

Five patients (all of them were military personnel) with thoracic spinal cord military injury consequences, lasting more than 6-12 months, were offered treatment in the frame of a research scientific program "To investigate the effectiveness of regenerative cell technologies in the neurosurgical treatment of patients with demyelinating diseases of the CNS and cerebral palsy. № 0119U000112". Neurosurgical treatment include: laminectomy, meticulous myeloradiculolysis with glial scar excision, and implantation of bioengineered constructs (gel composite) associated with mesenchymal stem cells (cultured MSCs from umbilical cord arteries, UCA-MSCs), augmented by implantation of epidural electrical stimulation device “NeySi-3M”, which is included in the State Register of Medical Equipment and Medical Devices of Ukraine and is permitted for use in medical practice (Certificate of State Registration No. 7439/2008). The UCA-MSCs used were isolated from healthy human umbilical cords and met the ISCT minimal criteria for mesenchymal stem cells. The commercial poly[N-(2-hydroxypropyl)-methacrylamide] (pHPMA) hydrogel was synthesized via heterogeneous polymerization and association in the laboratory of E. Pinet (FISO Technologies Inc., Canada)

Results/Findings: Objective signs of partial recovery within 10-14 months post-operation were noted. Specifically, observations included: improvement in lower limb muscle strength to 2b-3b points on the MRC scale in specific muscle groups (hip adductors, gluteus maximus muscles), recovery of deep sensation to level 3b on the MRC scale, emergence of superficial (tactile) sensation on the trunk and lower limbs in previously anesthetic zones, return of the sensation of bladder fullness.

Conclusions: Thus, despite encouraging signs of partial recovery, the persistence of key neurological problems – spastic paraplegia, lack of control over pelvic functions, and pain syndrome – underscores the extreme complexity of the task of complete functional rehabilitation for patients with severe CSCI. This demonstrates that modern regenerative approaches, although capable of positively modulating recovery processes, do not yet guarantee its completeness, while it should also be considered that the relatively short observation periods (up to 14 months in the presented cases) are insufficient for drawing final conclusions regarding the long-term effectiveness and full potential of these methods.