AO Spine Knowledge Forum Spinal Cord Injury (SCI)

PCI: Brian Kwon / Co-PCI: 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).

PI: Andrew H. Milby

Goals: The goal of this study is to investigate the correlation between altered spinal cord and brain activity patterns and the severity of the disease in patients with Cervical Spondylotic Myelopathy (CSM). 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.

PI: Allan R. Martin

Goal: The goal of this study is to develop the Degenerative Cervical Myelopathy Subjective and Objective Score (DCM-SOS). The DCM-SOS is intended to improve upon the mJOA by introducing more detailed scoring, additional questions, and objective physical tests. This tool aims to offer an accurate and reliable assessment of neurological dysfunction in degenerative cervical myelopathy (DCM) in under 10 minutes, without requiring specialized equipment.

PI: Aditya Vedantam

Goal: To identify a blood-based protein biomarker for diagnosis in DCM. For this purpose, an unbiased plasma proteomics to assess the circulating proteome before and after surgery will be used.

Prognostic Factors and Therapeutic Effects of Surgical Treatment for Traumatic Spinal Column Injury with Spinal Cord Injury: A Prospective, Observational European Multi-center Study.

PCI: Dr. Allard J.F. Hosman

Co-PCI: Dr. Giuseppe Barbagallo, MD, Dr. Joost J. van Middendorp

Goals: The SCI-POEM is a prospective, observational multicenter cohort study 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.

AO Spine RECODE DCM 2.0 “Acelerating Creation and Translation of kNOWledge for Degenerative Cervical Myelopathy“

PI: Benjamin Davies

Goals: RECODE DCM 2.0 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. Building on this work and to maintain momentum, RECODE DCM 2.0 is being launched. RECODE 2DCM 2.0 includes seven projects, referred to as an “ACTs” (Accelerating Creation and Translation) to accelerate knowledge discovery and its translation into practice, with the aim of improving care for people living with DCM. The ultimate goal is to re-invigorate the multidisciplinary, global community and focus on knowledge to action strategies.

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.

INTWIN GOV Number: https://www.clinicaltrials.gov/study/NCT05653206?cond=instability%20cervical&rank=6

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.

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. 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.

To learn more and join the global community, please go here

PI: Aminul Ahmed

Goals: This was a feasibility study to compare the use of TransCranial Magnetic stimulation as an outcome measure when compared to the standard assessments used in the EM-SCI csriteria. The aim was to recruit a mix of patients across all ASIA grades and both cervical and thoracic injuries.

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

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

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

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

Outcome:

The Translation of Nanomedicines in the Contexts of Spinal Cord Injury and Repair - PMC