Spinal Cord Injuries the Facts of Neuropathology: Opportunities and Limitations

  • Byron A Kakulas Perron Institute for Neurological and Translational Science, Western Australia
Keywords: Human spinal cord injury (SCI), Neuropathology of SCI, “cure” of SCI, Restorative Neurology of SCI


It is essential for research projects which are undertaken to find a “cure” for human spinal cord injury (SCI) to be consistent with the neuropathological facts of the disorder. In this respect there are three main points to be taken into account. Firstly, the researcher should be aware that simple transection of the spinal cord is not a feature of human SCI. The usual lesion is one of compression and disruption with haemorrhage. The second and most important aspect of human SCI is to understand that Wallerian degeneration inevitably ensues following disruption of the axon. Wallerian degeneration is progressive and inexorable and unlike the peripheral nervous system CNS axons do not regenerate. The third and more helpful fact is that in the majority (71%) of SCI autopsies a small amount of white matter, myelin and axons, was found to be preserved at the level of injury. Re-activation of these dormant, axons offers the opportunity for improvement of the SCI patient’s neurological status by means of restorative neurology (RN).


[1] National Spinal cord Injury Center. Facts and Figures at a Glance. SCI Data Sheet, 2016
[2] BA Kakulas. The applied neuropathology of human spinal cord injury, Spinal Cord 37(2), 79-88. 1999
[3] BA Kakulas. A review of the neuropathology of human spinal cord injury with emphasis on special features. The Journal of Spinal Cord Medicine 22(2), 119-124 1999.
[4] A Buss G A Brook B Kakulas D Martin R Franzen J Schoenen J Noth and A B Schmitt, Gradual loss of myelin and formation of an astrocytic scar during Wallerian degeneration in the human spinal cord Brain 127, 34-44, 2004
[5] El Masry W S Traumatic Spinal Cord Injury. The Relationship between Pathology and Clinical. Implications. Trauma 8, 29, 200
[6] Guttmann L. Spinal Cord Injuries. Comprehensive Management and Research 2nd Edition Blackwell Scientific Publications London, 1976
[7] Bedbrook GM. The Care and Management of Spinal Cord Injuries Springer Velag . 1981
[8] Dimitrijevic MR. Residual Motor Functions in Spinal Cord Injury. In Waxman SG (ed.) Functional Recovery in Neurological Disease. Raven Press New York. 139-155, 1988
[9] Keith E Tansey, William Barry McKay, Byron A Kakulas Restorative Neurology: Consideration of the new anatomy and physiology of the injured nervous system. Clinical Neurology and Neurosurgery 114, 436-440, 2012
[10] M R Dimitrijevic, BA Kakulas, W Barry McKay, G.Vrbova Eds. Restorative Neurology in Spinal Cord Injury. Oxford University Press New York, 2012
[11] BA Kakulas and Cahyono Kaelan. Neuropathological Foundations for the Restorative Neurology of Spinal Cord Injury. Clinical Neurology and Neurosurgery (Elsevier) 129, S17, 2015
[12] B A Kakulas. Neuropathology: the foundation for new treatments in spinal cord injury Sir Ludwig Guttmann Lecture. ISCoS Athens 2004. Spinal Cord 42, 549- 563, 2004