AO Spine Knowledge Forum Spinal Cord Injury (SCI)
AO Spine KF SCI at the Global Spine Congress 2019 in Toronto, ON, Canada The AO Spine KF SCI seeks to define new treatment approaches and address critical knowledge gaps to enhance outcomes for both traumatic and non-traumatic spinal cord injury patients by performing research projects that bring significant impact to the spine surgeon community. They will do this by addressing the following knowledge gaps:
- Central cord pattern of incomplete tetraplegia in the setting of a mechanically stable cervical spine: what is the role of early surgery?
- What tools could be used to better understand and characterize a cord injury? For example, MRI, intraoperative ultrasound?
- What is the best way of achieving decompression?
- What additional guidelines are necessary for surgeons treating SCI patients?
- Filling the knowledge gaps in degenerative cervical myelopathy (DCM) through the AO Spine RECODE project.
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IN-TWIN
Traumatic incomplete cervical tetraplegia without instability: a prospective multicenter feasibility study of outcomes and prognosis
Principal investigator:
Jefferson R. WilsonCo-Principal Investigator:
Brian KwonGoals:
To determine the feasibility of collecting a set of outcomes assessing hand function, gait, spasticity, neuropathic pain, and quality of life in incomplete cervical spinal cord injury patients without spinal instability and conduct exploratory analysis. The results of this study will be used to plan a large prospective study with the ultimate goal of identifying the role of timing of surgery in the management of this patient group. -
AO Spine-Praxis Clinical Practice Guidelines
Leadership team:
Brian Kwon
Michael Fehlings
Nathan Evaniew
Lindsay TetreaultGoals:
To generate three clinical practice guidelines to implement evidence into practice. These guidelines will contain evidence-based recommendations intended to optimize the care of spinal cord injury (SCI) patients worldwide. The guideline topics include:
1. Timing of surgical decompression (update of AO Spine guideline from 2017).
2. Hemodynamic management of acute SCI (update from AANS/CNS guideline from 2013).
3. Management of perioperative SCI (de novo guideline).
Collaborators:
Praxis Spinal Cord Injury Institute - https://praxisinstitute.org/
Aggregate Analytics Inc. -
Modulation of Inflammatory ResponsesModulation of Inflammatory Responses Using Neural Crest Derived Dental Pulp Stem Cells Following Acute Spinal Cord Injury
Principal investigator:
Ryan O’Hare Doig
Co-Principal investigators:
Brian James, Christopher Freeman, Stan Gronthos
Goals:
Aims to develop a better understanding of the pathophysiological pathways and effects of stem cell distribution, survival and differentiation, following spinal cord injury using advanced imaging and labelling techniques -
AO Spine RECODE-DCM
AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM)
Principal investigator:
Mark KotterCo-Principal investigator:
Benjamin DaviesGoals:
1. Aims to establish a standardized definition for DCM.
2. Create a list of unanswered DCM research questions, ranked according to priority.
3. Create a standardized set of baseline characteristics and outcomes which should be measured in DCM research.
4. To establish a Core Measurement Set
5. Form international special-interest ‘incubators’ focused on Natural History, Diagnostic Criteria, and Peri-Operative Rehabilitation to enhance synergy between research groups worldwide.Study website: www.aospine.org/recode
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RISCIS
A multi-center, randomized, placebo-controlled, double-blinded trial of the efficacy and safety of Riluzole in acute spinal cord injury
Principal investigator (PI):
Michael Fehlings
Goals:
Aims to evaluate the efficacy and safety of Riluzole in the treatment of patients with acute spinal cord injury. The primary objective is to evaluate the superiority of Riluzole, as compared to a placebo, in improving motor outcomes as measured by the ASIA Motor Score at six months follow-up, in patients with acute traumatic spinal cord injury, presenting to hospital less than 12 hours after injury.
Note:
Co-sponsored by AO Spine North America, US Department of Defense, Christopher and Dana Reeve Foundation, Ontario Neurotrauma Foundation, Rick Hansen Institute
Documents:
Publication summary
ClinicalTrials.gov Identifier: NCT01597518
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KFT SCI completed Database merge
Combining data from two existing registries (NACTN and STASCIS)
Principal investigator (PI):
Michael Fehlings
Goals:
To combine two existing databases on patients with spinal cord injuries treated surgically (NACTN and STASCIS) and to assess descriptive data on injury/surgery details, as well as the ASIA score and complications reportedDocuments:
Publication summary -
SCI-DCM Guidelines
Development of evidence-based clinical guidelines for the treatment of acute spinal cord injury (SCI)
Principal investigator:
Michael Fehlings
Goals:
A set of systematic reviews will deliver an understanding of the current state of the field. Based on this knowledge, a global team of clinical experts in SCI will then go through the rigorous process of developing evidence-based clinical guidelines for the treatment of acute spinal cord injury. Injury specific to the five selected topics:- Use of methylprednisolone
- Timing of decompression
- Role and timing of magnetic resonance imaging
- Type and timing of anticoagulation
- Type and timing of rehabilitation
Co-sponsored by AO Spine North America
Documents:
Guidelines Special Issue
Publication summary
Guidelines:
Access the guidelines here
Brian Kwon
Chairperson
University of British Columbia
Vancouver, Canada
Michael Fehlings
University of Toronto
Toronto, Canada
Shekar Kurpad
Froedtert & the Medical College of Wisconsin
Milwaukee, USA
James Harrop
Thomas Jefferson University
Philadelphia, USA
Bizhan Aarabi
University of Maryland
Baltimore, USA
Mark Kotter
University of Cambridge
Cambridge, UK
Vafa Rahimi-Movaghar
Tehran University of Medical Sciences
Tehran, Iran
James Guest
University of Miami
Miami, USA
KF SCI Associate Members
Benjamin Davies, University of Cambridge, Cambridge, UK
Ryan O’Hare Doig, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
Nathan Evaniew, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
Farzin Farahbakhsh, Tehran University of Medical Sciences, Tehran, Iran
Mario Ganau, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Daniel E. Graves, Thomas Jefferson University, Philadelphia, PA, USA
Yoon Ha, Severance Hospital College of Medicine, Yonsei University, Seoul, Korea
Christoph Hofstetter, University of Washington, Seattle, WA, USA
Rex Marco, Houston Methodist Hospital, Houston, TX, USA
Paul Koljonen, Queen Mary Hospital, The University of Hong Kong, China
Allan R. Martin, University of California, Davis, CA, USA
Narihito Nagoshi, Keio University School of Medicine, Tokyo, Japan
Hiroaki Nakashima, Nagoya University Graduate School of Medicine, Aichi, Japan
Chris Neal, Bethesda, MD, USA
Ricardo Rodrigues-Pinto, University of Porto, Porto, Portugal
Lindsay Tetreault, NYU Langone Health, New York, NY, USA
Aditya Vedantam, University of Miami, Miami, FL, USA
Paula Valerie ter Wengel, Haaglanden medisch centrum, Haaglanden, Netherlands
Jeff Wilson, St. Michael's Hospital, Toronto, ON, Canada
Knowledge Forum Manager
Olesja Hazenbiller
Senior Project Manager
“We are defining critical knowledge gaps that represent areas of research in the future. We’d like to see this lead to changes in clinical practice, improved outcomes, and changes in society with better access to care.”
Michael Fehlings