Spinal myelopathies and their contribution to enteric dysfunction

Abstract

Spinal myelopathies, characterized by neurological deficits due to spinal compression in the spinal column, are increasingly common in the aging population. Although spinal myelopathies commonly present with sensory and motor deficits, they also manifest with life-debilitating enteric dysfunction associated with increased gastroparesis, constipation, bloating, abdominal pain, neurogenic bowel disease, and bladder and bowel incontinence. That said, the effects of spinal myelopathies on enteric gastrointestinal (GI) function are still poorly understood. This review aims to summarize existing literature concerning spinal myelopathies and their effect on the GI system, including the relevant anatomy and physiology of the nervous systems, etiology of various spinal cord injuries, clinical manifestations, current diagnosis and treatment strategies, and ongoing research concerning the gut-brain-spinal axis. The autonomic nervous system contributes to GI innervation through enteric reflex arcs and communication with the central nervous system (CNS) via spinal nerves. When spinal cord damage occurs, enteric reflex arcs, autonomic regulation, and gut-brain-spinal axis can become impaired, leading to GI symptoms. Etiologies of spinal myelopathies occur at all spinal levels. Spinal myelopathy includes inflammatory processes, such as multiple sclerosis and infection, and non-inflammatory processes, such as spondylosis, degenerative disc disease, tumors, and traumatic spinal cord injuries. Diagnosis modalities include imaging, particularly MRI, and functional assessments, such as high-resolution anorectal manometry and colonic transit studies. Enteric dysfunction treatment includes non-pharmacological, pharmacological, neuromodulatory interventions, and surgery. These strategies encompass lifestyle modifications, laxatives, prosecretory agents, 5HT4 agonists, vagus nerve stimulation, sympathetic nerve stimulation, colostomy, and ileostomy. Despite these treatment options, ongoing research with pudendal nerve stimulation, transanal irrigation, mesenchymal stem cells, and the relationship between the gut microbiome and gut-brain-spinal nerve axis may be beneficial in understanding spinal cord myelopathy-related enteric dysfunction, diagnosis, and treatment, ultimately improving clinical outcomes and quality of life for those who are affected.

Keywords

Spinal myelopathies / enteric system / enteric dysfunction / autonomic regulation

References

[1] Seidenwurm DJ; Expert Panel on Neurologic Imaging. Myelopathy.AJNR Am J Neuroradiol.2008;29:1032-4.

[2] Oyinkan Marquis B,Capone PM.Myelopathy.Handb Clin Neurol.2016;136:1015-26.

[3] Singleton JM,Hefner M.Spinal Cord CompressionIn: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

[4] Pardo CA.Clinical Approach to Myelopathy Diagnosis.Continuum (Minneap Minn).2024;30:14-52.

[5] Kane SF,Abadie KV,Willson A.Degenerative Cervical Myelopathy: Recognition and Management.Am Fam Physician.2020;102:740-50.

[6] Young WB.The clinical diagnosis of myelopathy.Semin Ultrasound CT MR.1994;15:250-4.

[7] Donnally III CJ,Hanna A,Odom CK.Cervical MyelopathyIn: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

[8] McCormick JR,Sama AJ,Schiller NC,Butler AJ,Donnally CJ 3rd.Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management.J Am Board Fam Med.2020;33:303-13.

[9] Salvi FJ,Jones JC,Weigert BJ.The assessment of cervical myelopathy.Spine J.2006;6:182S-9S.

[10] Gibson J,Nouri A,Krueger B,Lakomkin N,Nasser R,Gimbel D,et al.Degenerative Cervical Myelopathy: A Clinical Review.Yale J Biol Med.2018;91:43-8.

[11] Bhattacharyya S.Spinal Cord Disorders: Myelopathy.Am J Med.2018;131:1293-7.

[12] Holmes GM,Blanke EN.Gastrointestinal dysfunction after spinal cord injury.Exp Neurol.2019;320:113009.

[13] Ng C,Prott G,Rutkowski S,Li Y,Hansen R,Kellow J,et al.Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors.Dis Colon Rectum.2005;48:1562-8.

[14] Stone JM,Nino-Murcia M,Wolfe VA,Perkash I.Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis.Am J Gastroenterol.1990;85:1114-9.

[15] Willits AB,Kader L,Eller O,Roberts E,Bye B,Strope T,et al.Spinal cord injury-induced neurogenic bowel: A role for host-microbiome interactions in bowel pain and dysfunction.Neurobiol Pain.2024;15:100156.

[16] Moura MM,Monteiro A,Salgado AJ,Silva NA,Monteiro S.Disrupted autonomic pathways in spinal cord injury: Implications for the immune regulation.Neurobiol Dis.2024;195:106500.

[17] Chung EA,Emmanuel AV.Gastrointestinal symptoms related to autonomic dysfunction following spinal cord injury.Prog Brain Res.2006;152:317-33.

[18] LeBouef T,Yaker Z,Whited L.Physiology, Autonomic Nervous SystemIn: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

[19] Waxenbaum JA,Reddy V,Varacallo MA.Anatomy, Autonomic Nervous SystemIn: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

[20] Holmes GM.Upper gastrointestinal dysmotility after spinal cord injury: is diminished vagal sensory processing one culprit?Front Physiol.2012;3:277.

[21] Lefèvre C,Le Roy C,Bessard A,Le Berre-Scoul C,Marchix J,Coron E,et al.Region-specific remodeling of the enteric nervous system and enteroendocrine cells in the colon of spinal cord injury patients.Sci Rep.2023;13:16902.

[22] Rao M,Gershon MD.The bowel and beyond: the enteric nervous system in neurological disorders.Nat Rev Gastroenterol Hepatol.2016;13:517-28.

[23] Michel K,Kuch B,Dengler S,Demir IE,Zeller F,Schemann M.How big is the little brain in the gut? Neuronal numbers in the enteric nervous system of mice, Guinea pig, and human.Neurogastroenterol Motil.2022;34:e14440.

[24] Avetisyan M,Schill EM,Heuckeroth RO.Building a second brain in the bowel.J Clin Invest.2015;125:899-907.

[25] Langley JN,Magnus R.Some observations of the movements of the intestine before and after degenerative section of the mesenteric nerves.J Physiol.1905;33:34-51.

[26] Furness JB,Johnson PJ,Pompolo S,Bornstein JC.Evidence that enteric motility reflexes can be initiated through entirely intrinsic mechanisms in the guinea-pig small intestine.Neurogastroenterol Motil.1995;7:89-96.

[27] Furness JB.The enteric nervous system and neurogastroenterology.Nat Rev Gastroenterol Hepatol.2012;9:286-94.

[28] Furness JB,Callaghan BP,Rivera LR,Cho HJ.The enteric nervous system and gastrointestinal innervation: integrated local and central control.Adv Exp Med Biol.2014;817:39-71.

[29] Sharkey KA,Mawe GM.The enteric nervous system.Physiol Rev.2023;103:1487-564.

[30] Brookes SJ,Spencer NJ,Costa M,Zagorodnyuk VP.Extrinsic primary afferent signalling in the gut.Nat Rev Gastroenterol Hepatol.2013;10:286-96.

[31] Sengupta JN.An overview of esophageal sensory receptors.Am J Med.2000;108:87S-9S.

[32] Kyloh M,Nicholas S,Zagorodnyuk VP,Brookes SJ,Spencer NJ.Identification of the visceral pain pathway activated by noxious colorectal distension in mice.Front Neurosci.2011;5:16.

[33] Furness JB,Costa M.The adrenergic innervation of the gastrointestinal tract.Ergeb Physiol.1974;69:2-51.

[34] McIntyre AS,Thompson DG.Review article: adrenergic control of motor and secretory function in the gastrointestinal tract.Aliment Pharmacol Ther.1992;6:125-42.

[35] Browning KN,Travagli RA.Central nervous system control of gastrointestinal motility and secretion and modulation of gastrointestinal functions.Compr Physiol.2014;4:1339-68.

[36] Vanner S,Surprenant A.Neural reflexes controlling intestinal microcirculation.Am J Physiol.1996;271:G223-30.

[37] Johnson ME,Humenick A,Peterson RA,Costa M,Wattchow DA,Sia TC,et al.Characterisation of parasympathetic ascending nerves in human colon.Front Neurosci.2022;16:1072002.

[38] De Groat WC,Krier J.The sacral parasympathetic reflex pathway regulating colonic motility and defaecation in the cat.J Physiol.1978;276:481-500.

[39] Lazarescu A,Turnbull GK,Vanner S.Investigating and treating fecal incontinence: when and how.Can J Gastroenterol.2009;23:301-8.

[40] Brading AF,Ramalingam T.Mechanisms controlling normal defecation and the potential effects of spinal cord injury.Prog Brain Res.2006;152:345-58.

[41] Stiens SA,Bergman SB,Goetz LL.Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management.Arch Phys Med Rehabil.1997;78:S86-102.

[42] Krogh K,Mosdal C,Laurberg S.Gastrointestinal and segmental colonic transit times in patients with acute and chronic spinal cord lesions.Spinal Cord.2000;38:615-21.

[43] Yim SY,Yoon SH,Lee IY,Rah EW,Moon HW.A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel.Spinal Cord.2001;39:204-7.

[44] Rodriguez GM,Gater DR.Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review.J Pers Med.2022;12:1141.

[45] Eldahan KC,Rabchevsky AG.Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management.Auton Neurosci.2018;209:59-70.

[46] Cowan H,Lakra C,Desai M.Autonomic dysreflexia in spinal cord injury.BMJ.2020;371:m3596.

[47] Han TR,Kim JH,Kwon BS.Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury.Spinal Cord.1998;36:485-90.

[48] Moore AP,Blumhardt LD.A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients.Spinal Cord.1997;35:361-7.

[49] Kelly JC,Groarke PJ,Butler JS,Poynton AR,O’Byrne JM.The natural history and clinical syndromes of degenerative cervical spondylosis.Adv Orthop.2012;2012:393642.

[50] Theodore N.Degenerative Cervical Spondylosis.N Engl J Med.2020;383:159-68.

[51] Nouri A,Tetreault L,Singh A,Karadimas SK,Fehlings MG.Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis.Spine (Phila Pa 1976).2015;40:E675-93.

[52] Choi YS.Pathophysiology of degenerative disc disease.Asian Spine J.2009;3:39-44.

[53] Voorhies RM.Cervical spondylosis: recognition, differential diagnosis, and management.Ochsner J.2001;3:78-84.

[54] Khattak ZK,Jiao X,Hu T,Shao Q,Sun X,Zhao X,et al.Investigation of gait and balance function in cervical spondylotic myelopathy patients using wearable sensors.Spine J.2023;23:1127-36.

[55] Davies BM,Munro C,Khan DZ,Fitzpatrick SM,Hilton B,Mowforth OD,et al.Outcomes of Degenerative Cervical Myelopathy From The Perspective of Persons Living With the Condition: Findings of a Semistructured Interview Process With Partnered Internet Survey.Global Spine J.2022;12:432-40.

[56] Nouri A,Badhiwala JH,Kato S,Reihani-Kermani H,Patel K,Wilson JR,et al.The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort.J Clin Med.2020;9:624.

[57] Mehrotra A,Jamdar J,Sharma P,Godbole C,Singh S,Das KK,et al.Constipation in degenerative cervico-thoracic spine myelopathy: a simple co-existence or a complex inter-relationship?Eur Spine J.2017;26:2318-23.

[58] Garg K,Aggarwal A.Effect of Cervical Decompression on Atypical Symptoms Cervical Spondylosis-A Narrative Review and Meta-Analysis.World Neurosurg.2022;157:207-17.e1.

[59] Tetreault L,Lange SF,Chotai S,Lupo M,Kryshtalskyj MT,Wilson JR,et al.A Systematic Review of Definitions for Dysphagia and Dysphonia in Patients Treated Surgically for Degenerative Cervical Myelopathy.Global Spine J.2022;12:1535-45.

[60] Lockey SD,Jauregui JJ,Cavanaugh DL,Koh EY,Shen FHT,Ludwig SC,et al.Diagnosis and Management of Thoracic Myelopathy.J Am Acad Orthop Surg.2024;32:815-22.

[61] Rujeedawa T,Mowforth OD,Davies BM,Yang C,Nouri A,Francis JJ,et al.Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis.Global Spine J.2024;14:1664-77.

[62] Zhai J,Guo S,Li J,Chen B,Zhao Y.Progression of Spinal Ligament Ossification in Patients with Thoracic Myelopathy.Orthop Surg.2022;14:1958-63.

[63] Ando K,Imagama S,Kobayashi K,Ito K,Tsushima M,Morozumi M,et al.Clinical Features of Thoracic Myelopathy: A Single-Center Study.J Am Acad Orthop Surg Glob Res Rev.2019;3:e18.00090.

[64] Siller S,Pannenbaecker L,Tonn JC,Zausinger S.Surgery of degenerative thoracic spinal stenosis-long-term outcome with quality-of-life after posterior decompression via an uni- or bilateral approach.Acta Neurochir (Wien).2020;162:317-25.

[65] Lim-Fat MJ,Dietrich J.Myelopathies from Neoplasms.Semin Neurol.2021;41:291-302.

[66] Hohenberger C,Hau P,Schebesch KM,Kölbl O,Riemenschneider MJ,Pohl F,et al.Spinal meningiomas.Neurooncol Adv.2023;5:i112-21.

[67] Hauck EF,Wittkowski W,Bothe HW.Intradural microanatomy of the nerve roots S1-S5 at their origin from the conus medullaris.J Neurosurg Spine.2008;9:207-12.

[68] Preziosi G,Gordon-Dixon A,Emmanuel A.Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies.Degener Neurol Neuromuscul Dis.2018;8:79-90.

[69] Brouwers E,van de Meent H,Curt A,Starremans B,Hosman A,Bartels R.Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review.Spinal Cord.2017;55:886-90.

[70] Kirnaz S,Capadona C,Wong T,Goldberg JL,Medary B,Sommer F,et al.Fundamentals of Intervertebral Disc Degeneration.World Neurosurg.2022;157:264-73.

[71] Rider LS,Marra EM.Cauda Equina and Conus Medullaris SyndromesIn: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

[72] Fraser S,Roberts L,Murphy E.Cauda equina syndrome: a literature review of its definition and clinical presentation.Arch Phys Med Rehabil.2009;90:1964-8.

[73] Korse NS,Pijpers JA,van Zwet E,Elzevier HW,Vleggeert-Lankamp CLA.Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction.Eur Spine J.2017;26:894-904.

[74] Barreras P,Fitzgerald KC,Mealy MA,Jimenez JA,Becker D,Newsome SD,et al.Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy.Neurology.2018;90:e12-21.

[75] Abbatemarco JR,Galli JR,Sweeney ML,Carlson NG,Samara VC,Davis H,et al.Modern Look at Transverse Myelitis and Inflammatory Myelopathy: Epidemiology of the National Veterans Health Administration Population.Neurol Neuroimmunol Neuroinflamm.2021;8:e1071.

[76] Tanaka ST,Stone AR,Kurzrock EA.Transverse myelitis in children: long-term urological outcomes.J Urol.2006;175:1865-8; discussion 1868.

[77] Chinnappan J,Parajuli A,Marcus H,Bachuwa G.Constipation in transverse myelitis.BMJ Case Rep.2023;16:e254409.

[78] Preziosi G,Raptis DA,Raeburn A,Thiruppathy K,Panicker J,Emmanuel A.Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease.Eur J Gastroenterol Hepatol.2013;25:1044-50.

[79] Alvino B,Arianna F,Assunta B,Antonio C,Emanuele D,Giorgia M,et al.Prevalence and predictors of bowel dysfunction in a large multiple sclerosis outpatient population: an Italian multicenter study.J Neurol.2022;269:1610-7.

[80] Ahuja CS,Wilson JR,Nori S,Kotter MRN,Druschel C,Curt A,et al.Traumatic spinal cord injury.Nat Rev Dis Primers.2017;3:17018.

[81] Liu CW,Huang CC,Yang YH,Chen SC,Weng MC,Huang MH.Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury.J Rehabil Med.2009;41:35-40.

[82] Desai MH,Gall A,Khoo M.Superior mesenteric artery syndrome - A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review.J Spinal Cord Med.2015;38:544-7.

[83] Klimo P Jr,Blumenthal DT,Couldwell WT.Congenital partial aplasia of the posterior arch of the atlas causing myelopathy: case report and review of the literature.Spine (Phila Pa 1976).2003;28:E224-8.

[84] Nishikawa K,Ludwig SC,Colón RJ,Fujimoto Y,Heller JG.Cervical myelopathy and congenital stenosis from hypoplasia of the atlas: report of three cases and literature review.Spine (Phila Pa 1976).2001;26:E80-6.

[85] Jiang Y,Xi Y,Ye X,Xu G,He H,Zhu Y.A cervical myelopathy caused by invaginated anomaly of laminae of the axis in spina bifida occulta with hypoplasia of the atlas: case report.Spine (Phila Pa 1976).2010;35:E351-5.

[86] Brochard C,Peyronnet B,Dariel A,Ménard H,Manunta A,Ropert A,et al.Bowel Dysfunction Related to Spina Bifida: Keep It Simple.Dis Colon Rectum.2017;60:1209-14.

[87] Camilleri M.Gastrointestinal motility disorders in neurologic disease.J Clin Invest.2021;131:e143771.

[88] Baar I,Jacobs BC,Govers N,Jorens PG,Parizel PM,Cras P.Campylobacter jejuni-induced acute transverse myelitis.Spinal Cord.2007;45:690-4.

[89] Sirbu CA,Mezei RM,Falup-Pecurariu C,Bratu OG,Sirbu AM,Ghinescu MC,et al.Autonomic dysfunctions in multiple sclerosis: Challenges of clinical practice (Review).Exp Ther Med.2020;20:196.

[90] Racosta JM,Kimpinski K,Morrow SA,Kremenchutzky M.Autonomic dysfunction in multiple sclerosis.Auton Neurosci.2015;193:1-6.

[91] Khanna L,Zeydan B,Kantarci OH,Camilleri M.Gastrointestinal motility disorders in patients with multiple sclerosis: A single-center study.Neurogastroenterol Motil.2022;34:e14326.

[92] Faber W,Stolwijk-Swuste J,van Ginkel F,Nachtegaal J,Zoetendal E,Winkels R,et al.Faecal Microbiota in Patients with Neurogenic Bowel Dysfunction and Spinal Cord Injury or Multiple Sclerosis-A Systematic Review.J Clin Med.2021;10:1598.

[93] Krassioukov A,Eng JJ,Claxton G,Sakakibara BM,Shum S.Neurogenic bowel management after spinal cord injury: a systematic review of the evidence.Spinal Cord.2010;48:718-33.

[94] Jiang Z,Davies B,Zipser C,Margetis K,Martin A,Matsoukas S,et al.AO Spine RECODE-DCM Diagnostic Criteria Incubator.The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis.Global Spine J.2024;14:1369-94.

[95] Uda T,Takami T,Tsuyuguchi N,Sakamoto S,Yamagata T,Ikeda H,et al.Assessment of cervical spondylotic myelopathy using diffusion tensor magnetic resonance imaging parameter at 3.0 tesla.Spine (Phila Pa 1976).2013;38:407-14.

[96] Sowulewski O,Bubińska M,Zagierska A,Zagierski M,Szlagatys-Sidorkiewicz A.High-Resolution Anorectal Manometry as a Screening Tool for Hirschsprung’s Disease: A Comprehensive Retrospective Analysis.J Clin Med.2024;13:1268.

[97] Rao SSC,Ahuja NK,Bharucha AE,Brenner DM,Chey WD,Deutsch JK,et al.Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations.Clin Gastroenterol Hepatol.2023;21:2727-39.e1.

[98] Norouzi A,Fatemi A,Livani S,Besharat S,Kami A.Measurement of colonic transit time in patients with refractory chronic constipation referred to a tertiary center.Gastroenterol Endosc.2024;2:70-3.

[99] Pons Carreto A,Ramírez Valencia M,de García Frutos A,Khoudeir Avila A,Montesinos Magraner L,et al.Myelopathy disability index: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy.Eur Spine J.2023;32:584-9.

[100] Tetreault L,Kopjar B,Nouri A,Arnold P,Barbagallo G,Bartels R,et al.The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy.Eur Spine J.2017;26:78-84.

[101] Hamilton AM,Blackmer-Raynolds L,Li Y,Kelly SD,Kebede N,Williams AE,et al.Diet-microbiome interactions promote enteric nervous system resilience following spinal cord injury.NPJ Biofilms Microbiomes.2024;10:75.

[102] Carabotti M,Scirocco A,Maselli MA,Severi C.The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems.Ann Gastroenterol.2015;28:203-9.

[103] Gao R,Tao Y,Zhou C,Li J,Wang X,Chen L,et al.Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials.Scand J Gastroenterol.2019;54:169-77.

[104] Aziz I,Whitehead WE,Palsson OS,Törnblom H,Simrén M.An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation.Expert Rev Gastroenterol Hepatol.2020;14:39-46.

[105] Payne SC,Furness JB,Stebbing MJ.Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms.Nat Rev Gastroenterol Hepatol.2019;16:89-105.

[106] Hocevar B,Gray M.Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.J Wound Ostomy Continence Nurs.2008;35:159-66.

[107] Calabrò RS,Leo A,Bramanti P.Pudendal nerve stimulation: a potential tool for neurogenic bowel dysfunction!.Neurourol Urodyn.2014;33:358-9.

[108] Emmanuel A,Kurze I,Krogh K,Ferreiro Velasco ME,Christensen P,Del Popolo G,et al.An open prospective study on the efficacy of Navina Smart, an electronic system for transanal irrigation, in neurogenic bowel dysfunction.PLoS One.2021;16:e0245453.

[109] Pagan-Rivera LH,Ocasio-Rivera SE,Godoy-Vitorino F,Miranda JD.Spinal cord injury: pathophysiology, possible treatments and the role of the gut microbiota.Front Microbiol.2024;15:1490855.

[110] Kamperidis N,Nightingale J.Neurological disorders and small bowel dysmotility.Curr Opin Gastroenterol.2022;38:299-306.

[111] Cofano F,Boido M,Monticelli M,Zenga F,Ducati A,Vercelli A,et al.Mesenchymal Stem Cells for Spinal Cord Injury: Current Options, Limitations, and Future of Cell Therapy.Int J Mol Sci.2019;20:2698.