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[Treatment of the future for spinal cord injuries].

Future therapy of spinal cord trauma is based on the careful analysis of pathophysiological phenomena secondary to the initial lesion. The toxicity of excitatory amino-acids, which is an early phenomenon, can be treated by specific antagonists. Axonal regrowth, which spontaneously occurs within days after the trauma must be supported by trophic factors on the one hand, and by blocking of the glial scar formation on the other hand. Finally, neuronal loss can be replaced by grafts either from embryonic neurons, or from genetically engineered cells, or direct gene therapy using viral vectors. Clinical applications are on their way for the early toxic phenomena, more remote for axonal regrowth and grafts. In any case, future treatment will have to use concurrently these three approaches, in specialized spinal units.