Section Spotlight
A Synopsis of the 2024 Spinal Cord Injury Guidelines by AO Spine Praxis: What Have We Learned? What are the Challenges and Knowledge Gaps?
Konstantinos Margetis, MD, PhD
Mount Sinai Health System New York, NY
Rajiv Saigal, MD, PhD
University of California San Francisco San Francisco, CA
Yi Lu, MD, PhD
Harvard Medical School, Brigham and Women’s Hospital Boston, MA
Michael G. Fehlings, MD, PhD
Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network; Institute of Medical Science, University of Toronto Toronto, ON, Canada
Author Konstantinos Margetis, MD, gives a brief preview of this article.
Abstract
The AO Spine and Praxis Spinal Cord Institute sponsored the development of clinical practice guidelines (CPGs) regarding spinal cord injury (SCI). The CPGs recommend surgery within 24 hours from injury as the preferred option for adult patients with acute SCI when medically feasible. The CPGs suggest Mean Arterial Pressure (MAP) be maintained above 75-80 mmHg but not actively augmented above 90-95 mmHg in acute traumatic SCI for a duration of 3-7 days. Additionally, intraoperative neurophysiological monitoring for patients at high risk for intraoperative SCI, is recommended as well. These patients should be identified prior to surgery.
Introduction
Spinal cord injury (SCI) is associated with significant disease burden, cost, and variability in management. Progress has been made, but SCI remains a great challenge. Clinical practice guidelines (CPGs) evaluate and summarize the evidence. Using an Evidence-to-Decision framework, recommendations are generated that help clinicians provide the best care. AO Spine and Praxis Spinal Cord Institute sponsored the development of SCI guidelines1 that build upon 2017 AO Spine SCI Guidelines. The 13 articles of the new guidelines are worth careful perusal; what follows is a condensed synopsis from members of North American Spine Society (NASS) SCI section.
Intent of the Guidelines
The CPGs provide specific and actionable recommendations that aim to optimize outcomes, standardize care, and reduce costs.2 They may also be used by the patients themselves to aid in decision-making or to inform health care policy decisions. However, it is important to emphasize that CPGs in general, should not be construed as the “standard of care.”3 CPGs are not intended to replace clinical judgment or be the only source of information for decision-making.4 Clinicians must make individualized decisions, ideally through a shared decision process with patients. The application of CPGs may further be constrained by the availability of local resources and timing. Finally, CPGs can become outdated due to the emergence of new evidence.