The review paper by Ramer et al1 ‘Setting the stage for functional repair of spinal cord injuries: a cast of thousands’ with the 417 references provide very strong evidence of the cast of thousands in the functional repair of spinal cord neurones.

The scientists in the reference list represent a huge intellectual resource, matched by the funding, for the search into better outcomes following spinal cord injury. This will continue while there is a perpetuation of the hope for a cure of the complete spinal cord injury and the general management of neuronal damage.

While we wait for the breakthrough, a realisation that gains in ‘functional’ status of many complete lesions will be reflected in a greater proportion of ‘partial lesions’ in the individuals presenting to rehabilitation. This will change the demographics of SCI. Unless researchers and funding become available to improve the efficacy of the rehabilitation of individuals with partial lesions, any breakthrough in the neurological repair of the spinal cord will remain academic, or worse an unfulfilled functional potential of the individual despite the ‘evidence’ of the ‘functional repair’ of the neurones.

Parallel funding for the development of sensitive scales that are able to determine efficacy of current and future interventions are needed now to avoid a lag between implementation of ‘breakthrough’ acute management and optimal rehabilitation for the individual.