American football has a proud place in professional and collegiate sports, not to mention in hometown culture. Lately, the focus in football has been on concussions and chronic traumatic encephalopathy, a degenerative brain disease linked to damage caused by repetitive hits to the head. Spinal cord injuries are also a serious problem, as one of us (R.L.) learned the hard way with an injury that ended his career with the Seattle Seahawks.
That’s why we have teamed up to help create a comprehensive three-dimensional atlas of the human spinal cord, a missing piece of the puzzle that will help improve the understanding and treatment of these difficult injuries. Football, of course, isn’t the only cause of spinal cord injuries.
According to the National Spinal Cord Injury Statistical Center, about 17,000 spinal cord injuries occur each year in the United States; more than 280,000 Americans are currently living with one. Motor vehicle crashes are the most common cause, followed by falls, acts of violence, and sports or recreational activities.
Depending on the location and severity of the injury, symptoms can vary widely. In general, the higher the injury on the spinal cord, the more function an individual will lose. The prognosis for a spinal cord injury ranges widely, from temporary loss of muscle function in the hips and legs to permanent paralysis in all four limbs (quadriplegia). A serious spinal cord injury may mean that an individual needs full-time in-home care and require complete assistance for all daily activities. These injuries wreak emotional havoc on patients and families, and pose a significant financial cost for the health care system as a whole.
The spinal cord is about 18 inches long. It emerges from the brain and descends through the bony spinal column, which acts as protective armor against injury (though it can also be the object that produces an injury). The cord is encased in cerebrospinal fluid, which acts as a shock absorber. Nerve roots branch off the cord at various intervals and control movement and sensory signals. Almost every area of the body can be affected by a spinal cord injury.
The spinal cord is fragile and easily damaged. Once injured, full functional recovery is rare — there are currently no known treatment options for repairing a damaged or bruised spinal cord.
One thing holding back the development of new treatments is a detailed atlas of the spinal cord. With a clearer understanding of this vital tissue at the macroscopic and microscopic levels, clinicians could better treat the complex chronic conditions linked with spinal cord injury.
To remedy this critical knowledge gap, we are part of a group of individuals affiliated with the Seattle Science Foundation who have embarked on a five-year, three-phase, $15 million initiative to create a comprehensive 3-D atlas of the human spinal cord. This initiative aims to analyze the spinal cord to a degree that has never before been done.
Phase 1 will create a comprehensive, open-access atlas of the anatomy of the normal spinal cord on the macroscopic level. The cord will be digitized using ultra-high-resolution and depth-of-field techniques. By combining techniques such as focal stacking, image stitching, and 3-D in-depth maps, the research team will be able to expose incredible detail at both the macroscopic and microscopic levels.
In phase 2, the team will analyze and map the microscopic anatomy of cells and tissues in the normal spinal cord. The cord will be sliced into thin sections, stained, and mounted onto slides for examination under high-power microscopes. All slides will be imaged and cataloged.
During phase 3, all of the data collected during the previous phases will be used to create an online, open-access, 3-D virtual atlas platform. This atlas will yield highly specific views of each layer of the spinal cord and its microcircuitry. That will give researchers and physicians greater knowledge of the precise areas of the spine that control specific muscles and functions.
This will make it possible to develop discreet electrodes and place them in the spinal cord with extreme precision so they can stimulate specific muscles. That could give an individual paralyzed by a spinal cord injury the ability to regain movement in the muscles below the site of the injury.
Of course, prevention is essential. We need to do a better job teaching athletes in every sport, from youths to professionals, injury-prevention techniques. We also need to develop safer sports equipment and introduce more protective and preventive protocols for contact sports to improve safety and reduce the risk of these devastating injuries.
But when the unthinkable happens, and a player or an ordinary citizen sustains an unforeseeable spinal cord injury, health care providers should be able to offer them treatment options to improve their function and quality of life. By creating a 3-D atlas of the spinal cord, we aim to help create that next generation of individualized spinal cord care.
Marc D. Moisi, M.D., is the chief of neurosurgery at DMC Detroit Receiving Hospital. R. Shane Tubbs, Ph.D., is vice president and chief scientific officer of the Seattle Science Foundation and editor-in-chief of the journal Clinical Anatomy. Ricardo Lockette is a retired Seattle Seahawks wide receiver and ambassador to the Seattle Science Foundation. He helped launch the foundation’s Spinal Cord Injury Research program.