Author response to Dr. Domingue

We agree with Dr. Domingue's observation that the trajectory of recovery after spinal cord injury (SCI) is complex and difficult to predict. We should clarify that in the present study, we investigated the effects of traumatic SCI on neurodegeneration across the neuroaxis.[1] However, we and others have shown that in cervical spondolytic myelopathy (ie, non-traumatic SCI) remote tissue specific cord pathology is also evident.[2, 3] Surprisingly, the extent of neurodegeneration is similar to traumatic SCI, although these patients with non-traumatic SCI had only mild clinical symptoms.[2] This suggests that, in a slow progressive disease (eg, cervical spondolytic myelopathy), the central nervous system can compensate for neurodegenerative processes for much longer; however, with time, the competition between processes of reorganization and neurodegeneration is lost in favor of the latter. Nevertheless, the clinical …