Current Practice of Acute Spinal Cord Injury Management: A Global Survey of Members from the AO Spine

Abstract

Study Design Cross-sectional, international survey. Objectives To examine current international practices as well as knowledge, adoption, and barriers to guideline implementation for acute spinal cord injury (SCI) management. Methods A survey was distributed to members of AO Spine. The questionnaire was structured to obtain demographic data and preferred acute SCI practices surrounding steroid use, hemodynamic management, and timing of surgical decompression. Results 593 members completed the survey including orthopaedic surgeons (54.3%), neurosurgeons (35.6%), and traumatologists (8.4%). Most (61.2%) respondents were from low and middle-income countries (LMICs). 53.6% of physicians used steroids for the treatment of acute SCIs. Respondents from LMICs were more likely to administer steroids than HICs (178 vs. 78; P < .001). 331 respondents (81.5%) answered that patients would receive mean arterial pressure (MAP) targeted treatment. In LMICs, SCI patients were less likely to be provided with MAP-targeted treatment (76.9%) as compared to HICs (89%; P < .05). The majority of respondents (87.8%) reported that patients would benefit from early decompression. Despite overwhelming evidence and surgeons’ responses that would offer early surgery, 62.4% of respondents stated they encounter logistical barriers in their institutions. This was particularly evident in LMICs, where 57.9% of respondents indicated that early intervention was unlikely to be accomplished, while only 21.1% of respondents from HICs stated the same ( P < .001). Conclusion This survey highlights challenges in the implementation of standardized global practices in the management of acute SCI. Future research efforts will need to refine SCI guidelines and address barriers to guideline implementation.

AO Spine/Praxis Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury: An Introduction to a Focus Issue

“…Hence, the effort was divided into 3 parts: defining "intra-operative SCI", characterizing its incidence and risk factors, reviewing the diagnostic accuracy of various intra-operative neurophysiologic monitoring techniques, and proposing a care pathway that surgeons may follow when faced with these situations. [24][25][26][27] Firstly, by considering neurological impairment that occurs around surgery and defining it as "SCI", we sought to de-stigmatize what is known to be a relatively rare event and acknowledge that even in the most technically skilled of hands and with the most meticulous technique, such events occur almost inevitably during the course of a spine surgeon's career (and that its occurrence does not mean that one is a "bad surgeon"). It is recognized that in the management of some pathologies, such as the resection of intramedullary tumors, the spinal cord is invariably going to be "injured" during the procedure and may result in a worsening of neurological function.…”

The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation?

“…[13][14][15] The third topic, on the diagnosis and management of ISCI, represents an entirely novel guideline effort and fills a significant knowledge gap in the literature. 16 To develop these guidelines, we utilized rigorous methodology that abided by current standards. 17 In the first step, a summary of the evidence was developed through systematic reviews of the literature using the PRISMA standards.…”

“… 13 - 15 The third topic, on the diagnosis and management of ISCI, represents an entirely novel guideline effort and fills a significant knowledge gap in the literature. 16 …”