Variations in Managing Acute Spinal Cord Injury in the North American Clinical Trials Network and Partner Institutes

Area of Science:

• Neurosurgery
• Trauma Surgery
• Spinal Cord Injury Research

Background:

• Acute spinal cord injury (SCI) management requires timely and evidence-based interventions.
• North American spine centers exhibit variations in managing acute SCI.
• Standardization of care protocols is needed to improve outcomes.

Purpose of the Study:

• To evaluate current management patterns for acute SCI among spine surgeons in North America.
• To identify variations in practices related to SCI treatment.
• To highlight areas needing evidence-based protocol development.

Main Methods:

• A survey-based study was conducted among spine surgeons in North America.
• Data collected included institutional demographics and specific acute SCI management practices.
• Key variables assessed: steroid use, surgical decompression timing, MAP/SCPP targets, and influence of AIS grade.

Main Results:

• Ninety-three percent of responding institutions were Level 1 trauma centers with immediate MRI access.
• Steroid use was uncommon (approx. 70% did not use), while 60% employed emergent cervical traction.
• Surgical decompression within 24 hours was a goal for 90%, with varied MAP/SCPP targets and lumbar drain utilization (30%).

Conclusions:

• Significant heterogeneity exists in acute SCI management across North American spine centers.
• Variability is notable in steroid administration, decompression timing, cervical traction, and lumbar drain use.
• Development of evidence-based protocols is recommended to reduce practice variation in SCI care.