AO Spine Knowledge Forum Spinal Cord Injury (SCI)

Principal Investigator:

Brian Kwon

Co-Principal Investigator:

Shekar Kurpad, Lukas Grassner

Goals:

The primary objective of this study is to determine the accuracy of serum NF-L and GFAP levels (i.e., the biomarkers) at different time points postinjury for predicting the severity of neurologic impairment at 6 months postinjury as either motor complete (AIS grade A/B) or motor incomplete (AIS grade C/D)

ClinicalTrials.gov Identifier: NCT06839300 

Remark:

This project stems from “SCRIBBLE”, a study led by the Principal Investigator, and is funded through a U.S. Department of Defense grant

Principal Investigator:

Jefferson Wilson

Goals: 

To review and summarize the existing evidence surrounding motion preserving surgical procedures for the treatment of degenerative cervical myelopathy

Remark:

This project is in collaboration with AO Spine North America.

Principal Investigators:

Mario Ganau, Valerie ter Wengel, Vafa Rahimi-Movaghar

Goals:

To survey the AO Spine community to assess the diffusion of the AO Spine/Praxis guidelines SCI guidelines and barriers to their adoption in order to support their integration into clinical practice

Principal Investigator:

Benjamin Davies

Goals: 

This is an extension of the RECODE-DCM 1.0 initiative, which identified the Top 10 Research Priorities—recognized as the most critical research questions in the field, defined an index term, and established a minimum dataset to standardize research and accelerate knowledge discovery.

AO Spine RECODE DCM 2.0 ACT for NOW includes seven projects, referred to as an “ACT” (Accelerating Creation and Translation) to accelerate knowledge discovery and its translation into practice, with the aim of improving care for people living with degenerative cervical myelopathy (DCM). The ultimate goal is to re-invigorate the multidisciplinary, global community and focus on knowledge to action strategies.

1. ACT 1 – Teach: Education syllabus
2. ACT 2 – Detect: Diagnostic criteria
3. ACT 3 – Origins: Definition for patients with acute spinal cord compression (ASCC) and guidelines for how to monitor patients with ASCC or DCM not managed surgically
4. ACT 4 – Image: Guidelines on spinal cord imaging for DCM
5. ACT 5 – Early Recovery After Surgery (ERAS) guidelines on the perioperative management in DCM
6. ACT 6 – Bridge: Minimum data set for preclinical research in DCM
7. ACT 7 – Benchmark: Minimum data set for knowledge translation in DCM

Additional information:

AO Spine RECODE 2.0 to help end disability in DCM

AO Spine continues to advance the field of Degenerative Cervical Myelopathy research through an incubator program

Principal Investigator:

Aditya Vedantam

Co-Principal Investigator:

Timothy B. Meier

Goals:

To identify a blood-based protein biomarker for diagnosis in degenerative cervical myelopathy (DCM). For this purpose, unbiased plasma proteomics will be used to assess the circulating proteome before and after surgery for DCM patients.

Principal Investigator:

Allan R. Martin

Co-Principal Investigators:

Mark Kotter, Benjamin Davies, Jefferson Wilson, Michael Fehlings

Goals:

To develop a novel outcome measure that measures the severity of neurological deficits in degenerative cervical myelopathy and that is evidence-based, accurate, reliable, valid, and practical. This tool would improve upon the mJOA by introducing more detailed scoring, additional questions, and objective physical tests, and would offer an accurate and reliable assessment of neurological dysfunction in under 10 minutes, without requiring specialized equipment.

Research Output:

Publication Summary

Principal Investigator:

Andrew H. Milby

Co-Principal Investigators:

S. Tim Yoon, Scott D. Boden, Jed A. Diekfuss, Greg D. Myer, Alexis B. Slutsky-Ganesh, Manish Anand

Goals:

To investigate the correlation between altered spinal cord and brain activity patterns and disease severity in patients with Cervical Spondylotic Myelopathy (CSM), using functional MRI. The study aims to determine whether these altered activity patterns can predict disease progression and provide critical information to better guide treatment decision-making for CSM patients.

Research Output:

Publication summary

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.

ClinicalTrials.gov Identifier: NCT05653206

Additional information:

Traumatic incomplete tetraplegia without instability

Principal Investigator:

Allard J.F. Hosman

Co-Principal Investigators:

Giuseppe Barbagallo, Joost J. van Middendorp

Goals:

To evaluate the effectiveness of early surgical treatment among patients with a traumatic spinal column injury. More specifically, the (1) neurological, (2) functional and (3) treatment complications outcomes will be compared between SCI patients with early (≤ 12 hours after the tSCI) and late (> 12 hours and < 14 days after the tSCI) surgical spinal decompression

ClinicalTrials.gov Identifier: NCT01674764

Remark:

This project was initiated by AO Spine Europe

Additional information

SCI-POEM highlights the challenges of conducting clinical observational studies on traumatic SCI

Research Output:

Publication summary

Principal investigators:

Brian Kwon, Michael Fehlings, Nathan Evaniew, Lindsay Tetrault

Goals:

Generated three clinical practice guidelines to implement evidence into practice. These guidelines 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).

Remark:

This project was in collaboration with:

• Praxis Spinal Cord Institute
• Aggregate Analytics Inc.

Additional Information:

New clinical practice guidelines for acute spinal cord injury

Research Outputs:

Publication summary

AO Spine & Praxis Spinal Cord Institute Guidelines for the Management of Acute Spinal Cord Injury

Flyer

Principal investigator:

Mark Kotter

Co-Principal investigator:

Benjamin Davies

Goals:

The AO Spine RECODE-DCM group created a ‘Research Toolkit’ to equip scientists with the tools to make their studies robust, comparable, and focused on the outcomes that matter most for people with Degenerative Cervical Myelopathy (DCM). To address the established research priorities, international special-interest ‘incubators’ (groups of clinicians, other healthcare professionals, and individuals with lived experience) were formed focusing on: Natural History, Diagnostic Criteria, and Peri-Operative Rehabilitation. These groups are led by Knowledge Forum representatives.

Remark:

This project was in collaboration with:

• myelopathy.org
• James Lind Alliance

Additional Information:

AO Spine RECODE-DCM

New research toolkit will change the way research on Degenerative Cervical Myelopathy (DCM) is conducted

Research Outputs:

Publication summary

Transforming Care for Degenerative Cervical Myelopathy: The Top Ten Priorities. Findings in Context From AO Spine RECODE-DCM, an International and Multi-Disciplinary Collaboration

Research Priorities

Naming DCM

Minimum Dataset

Principal investigator:

Aminul Ahmed

Co-Principal investigator:

Elizabeth Bradbury, Jose Pedro Lavrador, Francesco Vergani

Goals:

This feasibility study assessed the use of neuro-navigated Transcranial Magnetic Stimulation as an adjunct to standard assessments of function (EM-SCI assessments: ISNCSCI, WISCI-III, Walk Test, SCIM 3) in SCI patients. A mix of patients across all ASIA grades with cervical and thoracic injuries were included.

Research Output:

Publication summary 

Principal investigator:

Ryan O’Hare Doig

Co-Principal investigators:

Brian Freeman, Stan Gronthos

Goals:

Developed 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

Research Output:

Publication summary

Principal investigator:

James Guest

Co-Principal investigators:

Christopher Hofstetter, Chris Neal

Goals:

They obtained spine surgeons’ input to understand the feasibility and utility of intraoperative ultrasound in managing spinal cord injury patients through a short survey.

Research Output:

Publication summary

Principal investigator:

Jefferson Wilson

Goals:

Developed a classification system to objectively classify cervical spinal cord injury (SCI) patients in order to facilitate communication and guide surgical decision making in the acute hospital period. It remains to be validated.

Research Outputs:

Publication Summary 

Principal investigator:

Michael Fehlings

Goals:

A set of systematic reviews deliver an understanding of the current state of the field. Based on this knowledge, a global team of clinical SCI experts underwent a rigorous process to develop evidence-based clinical practice guidelines for the treatment of acute spinal cord injury, specific to the five selected topics:

1. Use of methylprednisolone
2. Timing of decompression
3. Role and timing of magnetic resonance imaging
4. Type and timing of anticoagulation
5. Type and timing of rehabilitation

Remark:

Co-sponsored by AO Spine North America

Research Outputs:

Publication summary

Special issue: Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury

Principal investigator:

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.

ClinicalTrials.gov Identifier: NCT01597518

Remarks:

Co-sponsored by AO Spine North America, U.S. Department of Defense, Christopher and Dana Reeve Foundation, Ontario Neurotrauma Foundation, Rick Hansen Institute

Research Output:

Publication summary

The project was discontinued before completion

Principal investigator:

Michael Fehlings

Goals:

Combined two existing databases on patients with spinal cord injuries treated surgically (NACTN and STASCIS), and assessed descriptive data on injury/surgery details, as well as the ASIA score and complications reported

Research Output:

Publication summary