AO Spine Knowledge Forum Spinal Cord Injury (SCI)

Building on worldwide research partnerships for global impact

Goals

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.

Ongoing research projects

  • IN-TWIN

    Traumatic incomplete cervical tetraplegia without instability: a prospective multicenter feasibility study of outcomes and prognosis

    Principal investigator:
    Jefferson R. Wilson

    Co-Principal Investigator:
    Brian Kwon

    Goals:
    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 Tetreault

    Goals:
    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 Responses
    Modulation 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 Kotter

    Co-Principal investigator:
    Benjamin Davies

    Goals:
    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

    AO Spine RECODE-DCM community

     

  • 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

Completed research projects

  • 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 reported

    Documents:
    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
    Note:
    Co-sponsored by AO Spine North America

    Documents:
    Guidelines Special Issue
    Publication summary

    Guidelines:
    Access the guidelines here

KF Spinal cord injury (SCI) Steering Committee

Brian Kwon

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

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

Olesja Hazenbiller

Senior Project Manager

Other Knowledge Forums

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KF Deformity

AO Spine KF Deformity

KF Trauma

AO Spine KF Trauma

KF Degeneration

AO Spine KF Degenerative

“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

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