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Nerve grafting of the injured spinal cord should pursue a sixfold attack: lysing the fibrosis/gliosis to an extent that allows settling of the basal lamina preventing mean‐ while collapse of the neural tissue matrix; supplying the tissue matrix with a suitable scaffold, on which the basal lamina can settle; basal lamina synthesis; seeding the basal lamina with cell adhesion molecules; providing the axonal growth cone with neurite outgrowth promoting factors that allow its distal progression; supplying the axonal growth cone with neurotrophic factors that power its continued growth. In addition to this, the intrinsic properties of the neurons should be stimulated, possibly through modulating the function of astrocytes by heparin, aspirin and other factors. Nerve side grafting of the cord increases the incidence of nerve regeneration by applying additional grafts extending from the side of the donor end of the cord to the side of the recipient end. Also, it allows the surgeon to enhance regeneration through a partially regenerat‐ ed cord. During surgery, after establishment of CSF circulation, a long-lasting indwelling catheter has to be inserted for postoperative drug and cell delivery. This allows for continual lysis of the gliosis by chondroitinase ABC, sialidase and other factors.

Bridging Defects in Chronic Spinal Cord Injury Using Peripheral Nerve Grafts: From Basic Science to Clinical Experience