Kakulas B A
Paraplegia. 1987 Jun;25(3):212-6. doi: 10.1038/sc.1987.37.
The neuropathology of spinal cord injury (SCI) is reviewed in the light of clinical problems and as a guide to future research. The pathology of SCI in the acute stage suggests that the spinal cord may be partly preserved even in the most severe injuries. This finding emphasises the need for great care in roadside management. In the acute phase there are irreversible changes and possibly reversible changes which have not been adequately identified. Even a small percentage of nerve fibres escaping the initial injury would be of great benefit to the patient. In the subacute stage when transynaptic degeneration is proceeding there may also be associated functional changes leading to abnormal reflex activity. It is possible through an improved understanding of the neuropathology and neurophysiology of the isolated or partly isolated segments of the cord that new reflex connections may be stimulated to develop by artificial means. In the chronic stage there are well recognised complications such as osteoarthrosis with spinal stenosis, post-traumatic syringomyelia and traumatic nerve root neuroma formation, which may lead to clinical deterioration and which may be amenable to treatment. In a more theoretical sense it is possible that improved understanding of CNS plasticity and transplant neurobiology using recombinant DNA technology, grafting and 're-education' of the regenerated tissues may be rewarding in the longterm future. Although this outcome is entirely hypothetical at this stage basic research deserves great emphasis.
本文根据临床问题对脊髓损伤（SCI）的神经病理学进行综述，并以此作为未来研究的指南。SCI急性期的病理学表明，即使在最严重的损伤中，脊髓也可能部分保留。这一发现强调了在现场处理时需格外小心的必要性。在急性期，存在尚未被充分识别的不可逆变化以及可能可逆的变化。即使只有一小部分神经纤维逃过了初始损伤，也会对患者大有裨益。在亚急性期，当跨突触变性进行时，也可能会有相关的功能变化，导致异常反射活动。通过更好地理解脊髓孤立或部分孤立节段的神经病理学和神经生理学，有可能通过人工手段刺激新的反射连接形成。在慢性期，存在诸如伴有椎管狭窄的骨关节炎、创伤后脊髓空洞症和创伤性神经根神经瘤形成等公认的并发症，这些并发症可能导致临床病情恶化，并且可能适合治疗。从更理论的角度来看，利用重组DNA技术、移植和对再生组织的“再教育”来更好地理解中枢神经系统可塑性和移植神经生物学，从长远来看可能会有成效。尽管现阶段这一结果完全是假设性的，但基础研究仍值得高度重视。
