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1. A minimum data set-Core outcome set, core data elements, and core measurement set-For degenerative cervical myelopathy research (AO Spine RECODE DCM): A consensus study

Author

Davies, Benjamin M., Yang, Xiaoyu, Khan, Danyal Z., Mowforth, Oliver D., Touzet, Alvaro Y., Nouri, Aria, Harrop, James S., Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N., Guest, James D., Tetreault, Lindsay, Kwon, Brian K., Boerger, Timothy F., Rodrigues-Pinto, Ricardo, Furlan, Julio C., Chen, Robert, Zipser, Carl M., Curt, Armin, Milligan, James, Kalsi-Rayn, Sukhivinder, Sarewitz, Ellen, Sadler, Iwan, Blizzard, Tammy, Treanor, Caroline, Anderson, David, Fallah, Nader, Hazenbiller, Olesja, Salzman, Carla, Zimmerman, Zachary, Wandycz, Anne M., Widdop, Shirley, Reeves, Margaret, Raine, Rye, Ryan, Sukvinder K., Malone, Ailish, Gharooni, Ali, Wilson, Jefferson R., Martin, Allan R., Fehlings, Michael G., McNair, Angus G. K., and Kotter, Mark R. N.

Subjects
Medical research -- Methods -- Standards -- Information management, Medicine, Experimental -- Methods -- Standards -- Information management, Spinal diseases -- Research, Degeneration (Pathology) -- Research, Company systems management, Biological sciences
Abstract

Background Degenerative cervical myelopathy (DCM) is a progressive chronic spinal cord injury estimated to affect 1 in 50 adults. Without standardised guidance, clinical research studies have selected outcomes at their discretion, often underrepresenting the disease and limiting comparability between studies. Utilising a standard minimum data set formed via multi-stakeholder consensus can address these issues. This combines processes to define a core outcome set (COS)-a list of key outcomes-and core data elements (CDEs), a list of key sampling characteristics required to interpret the outcomes. Further 'how' these outcomes should be measured and/or reported is then defined in a core measurement set (CMS). This can include a recommendation of a standardised time point at which outcome data should be reported. This study defines a COS, CDE, and CMS for DCM research. Methods and findings A minimum data set was developed using a series of modified Delphi processes. Phase 1 involved the setup of an international DCM stakeholder group. Phase 2 involved the development of a longlist of outcomes, data elements, and formation into domains. Phase 3 prioritised the outcomes and CDEs using a two-stage Delphi process. Phase 4 determined the final DCM minimal data set using a consensus meeting. Using the COS, Phase 5 finalised definitions of the measurement construct for each outcome. In Phase 6, a systematic review of the literature was performed, to scope and define the psychometric properties of measurement tools. Phase 7 used a modified Delphi process to inform the short-listing of candidate measurement tools. The final measurement set was then formed through a consensus meeting (Phase 8). To support implementation, the data set was then integrated into template clinical research forms (CRFs) for use in future clinical trials (Phase 9). In total, 28 outcomes and 6 domains (Pain, Neurological Function, Life Impact, Radiology, Economic Impact, and Adverse Events) were entered into the final COS. Thirty two outcomes and 4 domains (Individual, Disease, Investigation, and Intervention) were entered into the final CDE. Finally, 4 outcome instruments (mJOA, NDI, SF-36v2, and SAVES2) were identified for the CMS, with a recommendation for trials evaluating outcomes after surgery, to include baseline measurement and at 6 months from surgery. Conclusions The AO Spine RECODE-DCM has produced a minimum data set for use in DCM clinical trials today. These are available at https://myelopathy.org/minimum-dataset/. While it is anticipated the CDE and COS have strong and durable relevance, it is acknowledged that new measurement tools, alongside an increasing transition to study patients not undergoing surgery, may necessitate updates and adaptation, particularly with respect to the CMS., Author(s): Benjamin M. Davies 1,2,*, Xiaoyu Yang 1, Danyal Z. Khan 3,4, Oliver D. Mowforth 1,2, Alvaro Y. Touzet 5, Aria Nouri 1,6, James S. Harrop 7, Bizhan Aarabi 8, [...]

Published
2024
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2. Lived experience-centred word clouds may improve research uncertainty gathering in priority setting partnerships

Author

Mowforth, Oliver D., Burn, Lance, Khan, Danyal Z., Yang, Xiaoyu, Stacpoole, Sybil R. L., Gronlund, Toto, Tetreault, Lindsay, Kalsi-Ryan, Sukhvinder, Starkey, Michelle L., Sadler, Iwan, Sarewitz, Ellen, Houlton, Delphine, Carter, Julia, Howard, Paige, Rahimi-Movaghar, Vafa, Guest, James D., Aarabi, Bizhan, Kwon, Brian K., Kurpad, Shekar N., Harrop, James, Wilson, Jefferson R., Grossman, Robert, Smith, Emma K., McNair, Angus, Fehlings, Michael G., Kotter, Mark R. N., and Davies, Benjamin M.

Published
2023
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3. Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]

Author

Martin, Allan R, Tetreault, Lindsay, Nouri, Aria, Curt, Armin, Freund, Patrick, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Fehlings, Michael G, Kwon, Brian K, Harrop, James S, Davies, Benjamin M, Kotter, Mark RN, Guest, James D, Aarabi, Bizhan, and Kurpad, Shekar N

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurodegenerative, Clinical Research, Neurosciences, Spinal Cord Injury, Physical Injury - Accidents and Adverse Effects, Biomedical Imaging, Traumatic Head and Spine Injury, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Neurological, cervical myelopathy, imaging, diagnosis, electrophysiology, spinal cord compression, magnetic resonance, neural damage, microstructure, assessment, Clinical sciences
Abstract

Study designNarrative review.ObjectiveThe current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally.MethodsA narrative review was conducted to summarize the existing literature and highlight future directions.ResultsAnatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function.ConclusionCurrently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.

Published
2022

4. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Author

Davies, Benjamin M, Mowforth, Oliver, Gharooni, Aref-Ali, Tetreault, Lindsay, Nouri, Aria, Dhillon, Rana S, Bednarik, Josef, Martin, Allan R, Young, Adam, Takahashi, Hitoshi, Boerger, Timothy F, Newcombe, Virginia FJ, Zipser, Carl Moritz, Freund, Patrick, Koljonen, Paul Aarne, Rodrigues-Pinto, Ricardo, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Kurpad, Shekar N, Fehlings, Michael G, Kwon, Brian K, Harrop, James S, Guest, James D, Curt, Armin, and Kotter, Mark RN

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Traumatic Head and Spine Injury, Neurosciences, Spinal Cord Injury, Neurodegenerative, Physical Injury - Accidents and Adverse Effects, cervical, myelopathy, spondylosis, spondylotic, stenosis, disc herniation, ossification posterior longitudinal ligament, degeneration, disability, recovery, questionnaire, Clinical sciences
Abstract

Study designLiterature Review (Narrative).ObjectiveTo propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5.MethodsDegenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework.ResultsPresent pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time.ConclusionUnderstanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.

Published
2022

5. Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

Author

Nouri, Aria, Tessitore, Enrico, Molliqaj, Granit, Meling, Torstein, Schaller, Karl, Nakashima, Hiroaki, Yukawa, Yasutsugu, Bednarik, Josef, Martin, Allan R, Vajkoczy, Peter, Cheng, Joseph S, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Davies, Benjamin M, Kotter, Mark RN, and Wilson, Jefferson R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Spinal Cord Injury, Clinical Research, Traumatic Head and Spine Injury, Neurodegenerative, Physical Injury - Accidents and Adverse Effects, Neurosciences, cervical spondylotic myelopathy, cord compression, ossification of the posterior longitudinal ligament, progression, risk factors, Clinical sciences
Abstract

Study designNarrative review.ObjectivesTo discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).MethodsLiterature review summarizing current evidence pertaining to the natural history and risk factors of DCM.ResultsDCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years.ConclusionCurrent estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

Published
2022

9. An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery

Author

Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Tetreault, Lindsay A, Hachem, Laureen; https://orcid.org/0000-0002-5886-9935, Evaniew, Nathan; https://orcid.org/0000-0003-1974-5224, Ganau, Mario, McKenna, Stephen L; https://orcid.org/0000-0003-2030-8988, Neal, Chris J; https://orcid.org/0000-0002-5072-6454, Nagoshi, Narihito; https://orcid.org/0000-0001-8267-5789, Rahimi-Movaghar, Vafa, Aarabi, Bizhan, Hofstetter, Christoph P, Wengel, Valerie Ter, Nakashima, Hiroaki; https://orcid.org/0000-0002-0039-9678, Martin, Allan R; https://orcid.org/0000-0002-9495-5654, Kirshblum, Steven, Rodrigues Pinto, Ricardo; https://orcid.org/0000-0002-6903-348X, Marco, Rex A W; https://orcid.org/0000-0003-3393-1672, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Kahn, David E; https://orcid.org/0000-0002-9390-5938, Newcombe, Virginia F J, Zipser, Carl M; https://orcid.org/0000-0002-4396-4796, Douglas, Sam, Kurpad, Shekar N, Lu, Yi; https://orcid.org/0000-0001-8180-8578, Saigal, Rajiv, Samadani, Uzma, Arnold, Paul M; https://orcid.org/0000-0002-4622-7695, Hawryluk, Gregory W J, Skelly, Andrea C, Kwon, Brian K, Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Tetreault, Lindsay A, Hachem, Laureen; https://orcid.org/0000-0002-5886-9935, Evaniew, Nathan; https://orcid.org/0000-0003-1974-5224, Ganau, Mario, McKenna, Stephen L; https://orcid.org/0000-0003-2030-8988, Neal, Chris J; https://orcid.org/0000-0002-5072-6454, Nagoshi, Narihito; https://orcid.org/0000-0001-8267-5789, Rahimi-Movaghar, Vafa, Aarabi, Bizhan, Hofstetter, Christoph P, Wengel, Valerie Ter, Nakashima, Hiroaki; https://orcid.org/0000-0002-0039-9678, Martin, Allan R; https://orcid.org/0000-0002-9495-5654, Kirshblum, Steven, Rodrigues Pinto, Ricardo; https://orcid.org/0000-0002-6903-348X, Marco, Rex A W; https://orcid.org/0000-0003-3393-1672, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Kahn, David E; https://orcid.org/0000-0002-9390-5938, Newcombe, Virginia F J, Zipser, Carl M; https://orcid.org/0000-0002-4396-4796, Douglas, Sam, Kurpad, Shekar N, Lu, Yi; https://orcid.org/0000-0001-8180-8578, Saigal, Rajiv, Samadani, Uzma, Arnold, Paul M; https://orcid.org/0000-0002-4622-7695, Hawryluk, Gregory W J, Skelly, Andrea C, and Kwon, Brian K

Abstract

STUDY DESIGN Clinical practice guideline development. OBJECTIVES Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that "early" surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI). METHODS A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the "evidence-to-recommendation" framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with

Published
2024

10. Cervical spinal cord angiography and vessel‐selective perfusion imaging in the rat.

Author

Lee, Seongtaek, Schmit, Brian D., Kurpad, Shekar N., and Budde, Matthew D.

Subjects
CERVICAL cord, SPINAL cord, PERFUSION imaging, ANGIOGRAPHY, VERTEBRAL artery
Abstract

Arterial spin labeling (ASL) has been widely used to evaluate arterial blood and perfusion dynamics, particularly in the brain, but its application to the spinal cord has been limited. The purpose of this study was to optimize vessel‐selective pseudocontinuous arterial spin labeling (pCASL) for angiographic and perfusion imaging of the rat cervical spinal cord. A pCASL preparation module was combined with a train of gradient echoes for dynamic angiography. The effects of the echo train flip angle, label duration, and a Cartesian or radial readout were compared to examine their effects on visualizing the segmental arteries and anterior spinal artery (ASA) that supply the spinal cord. Lastly, vessel‐selective encoding with either vessel‐encoded pCASL (VE‐pCASL) or super‐selective pCASL (SS‐pCASL) were compared. Vascular territory maps were obtained with VE‐pCASL perfusion imaging of the spinal cord, and the interanimal variability was evaluated. The results demonstrated that longer label durations (200 ms) resulted in greater signal‐to‐noise ratio in the vertebral arteries, improved the conspicuity of the ASA, and produced better quality maps of blood arrival times. Cartesian and radial readouts demonstrated similar image quality. Both VE‐pCASL and SS‐pCASL adequately labeled the right or left vertebral arteries, which revealed the interanimal variability in the segmental artery with variations in their location, number, and laterality. VE‐pCASL also demonstrated unique interanimal variations in spinal cord perfusion with a right‐sided dominance across the six animals. Vessel‐selective pCASL successfully achieved visualization of the arterial inflow dynamics and corresponding perfusion territories of the spinal cord. These methodological developments provide unique insights into the interanimal variations in the arterial anatomy and dynamics of spinal cord perfusion. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Radiographic Modalities

Author

Nguyen, Ha Son, Kurpad, Shekar N., Kaiser, Michael G., editor, Haid, Regis W., editor, Shaffrey, Christopher I., editor, and Fehlings, Michael G., editor

Published
2019
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14. The development of lived experience-centered word clouds to support research uncertainty gathering in degenerative cervical myelopathy: results from an engagement process and protocol for their evaluation, via a nested randomized controlled trial

Author

Davies, Benjamin M., Mowforth, Oliver D., Khan, Danyal Z., Yang, Xiaoyu, Stacpoole, Sybil R. L., Hazenbiller, Olesja, Gronlund, Toto, Tetreault, Lindsay, Kalsi-Ryan, Sukhvinder, Starkey, Michelle L., Sadler, Iwan, Sarewitz, Ellen, Houlton, Delphine, Carter, Julia, Howard, Evangeline, Rahimi-Movaghar, Vafa, Guest, James D., Aarabi, Bizhan, Kwon, Brian K., Kurpad, Shekar N., Harrop, James, Wilson, Jefferson R., Grossman, Robert, Smith, Emma K., McNair, Angus G.K., Fehlings, Michael G., and Kotter, Mark R. N.

Published
2021
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15. We Choose to Call it 'Degenerative Cervical Myelopathy': Findings of AO Spine RECODE-DCM, an International and Multi-Stakeholder Partnership to Agree a Standard Unifying Term and Definition for a Disease.

Author

Davies, Benjamin M., Khan, Danyal Z, Barzangi, Kara, Ali, Ahmad, Mowforth, Oliver D., Nouri, Aria, Harrop, James S., Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D., Tetreault, Lindsay, Kwon, Brian K., Boerger, Timothy F, Rodrigues-Pinto, Ricardo, Furlan, Julio C., Chen, Robert, Zipser, Carl Moritz, Curt, Armin, and Milligan, James

Subjects
SPINAL cord diseases, LITERATURE reviews, SPINAL canal, DELPHI method, NOSOLOGY, CERVICAL spondylotic myelopathy, SPINAL cord injuries
Abstract

Study Design: Modified DELPHI Consensus Process Objective: To agree a single unifying term and definition. Globally, cervical myelopathy caused by degenerative changes to the spine is known by over 11 different names. This inconsistency contributes to many clinical and research challenges, including a lack of awareness. Method: AO Spine RECODE-DCM (Research objectives and Common Data Elements Degenerative Cervical Myelopathy). To determine the index term, a longlist of candidate terms and their rationale, was created using a literature review and interviews. This was shared with the community, to select their preferred terms (248 members (58%) including 149 (60%) surgeons, 45 (18%) other healthcare professionals and 54 (22%) People with DCM or their supporters) and finalized using a consensus meeting. To determine a definition, a medical definition framework was created using inductive thematic analysis of selected International Classification of Disease definitions. Separately, stakeholders submitted their suggested definition which also underwent inductive thematic analysis (317 members (76%), 190 (59%) surgeons, 62 (20%) other healthcare professionals and 72 (23%) persons living with DCM or their supporters). Using this definition framework, a working definition was created based on submitted content, and finalized using consensus meetings. Results: Degenerative Cervical Myelopathy was selected as the unifying term, defined in short, as a progressive spinal cord injury caused by narrowing of the cervical spinal canal Conclusion: A consistent term and definition can support education and research initiatives. This was selected using a structured and iterative methodology, which may serve as an exemplar for others in the future. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Safety and Efficacy of Riluzole in Acute Spinal Cord Injury Study (RISCIS): A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial

Author

Fehlings, Michael G., primary, Moghaddamjou, Ali, additional, Harrop, James S., additional, Stanford, Ralph, additional, Ball, Jonathon, additional, Aarabi, Bizhan, additional, Freeman, Brian J. C., additional, Arnold, Paul M., additional, Guest, James D., additional, Kurpad, Shekar N., additional, Schuster, James M., additional, Nassr, Ahmad, additional, Schmitt, Karl M., additional, Wilson, Jefferson R., additional, Brodke, Darrel S., additional, Ahmad, Faiz U., additional, Yee, Albert, additional, Ray, Wilson Z., additional, Brooks, Nathaniel P., additional, Wilson, Jason, additional, Chow, Diana S-L, additional, Toups, Elizabeth G., additional, and Kopjar, Branko, additional

Published
2023
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20. High-resolution in vivo diffusion tensor imaging of the injured cat spinal cord using self-navigated, interleaved, variable-density spiral acquisition (SNAILS-DTI)

Author

Ellingson, Benjamin M, Sulaiman, Olawale, and Kurpad, Shekar N

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Bioengineering, Neurodegenerative, Physical Injury - Accidents and Adverse Effects, Neurosciences, Traumatic Head and Spine Injury, Biomedical Imaging, Spinal Cord Injury, Algorithms, Animals, Cats, Diagnostic Imaging, Diffusion Magnetic Resonance Imaging, Diffusion Tensor Imaging, Female, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Normal Distribution, Pilot Projects, Spinal Cord, Spinal Cord Injuries, DTI, Diffusion tensor imaging, Spiral MRI, SNAILS, Spinal cord injury, Cat, SCI, Biomedical Engineering, Cognitive Sciences, Nuclear Medicine & Medical Imaging, Clinical sciences
Abstract

Diffusion tensor magnetic resonance imaging (DTI) is useful for studying the microstructural changes in the spinal cord following traumatic injury; however, image quality is generally poor due to the small size of the spinal cord, physiological motion and susceptibility artifacts. Self-navigated, interleaved, variable-density spiral diffusion tensor imaging (SNAILS-DTI) is a distinctive pulse sequence that bypasses many of the challenges associated with DTI of the spinal cord, particularly if imaging gradient hardware is of conventional quality. In the current study, we have demonstrated the feasibility of implementing SNAILS-DTI on a clinical 3.0-T MR scanner and examined the effect of navigator filter parameters on image quality and reconstruction time. Results demonstrate high-quality, high-resolution (546 μm×546 μm) in vivo DTI images of the cat spinal cord after traumatic spinal cord injury.

Published
2010

21. An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery

Author

Fehlings, Michael G., Kwon, Brian K., Evaniew, Nathan, Tetreault, Lindsay A., Fehlings, Michael G., Tetreault, Lindsay A., Hachem, Laureen, Evaniew, Nathan, Ganau, Mario, McKenna, Stephen L., Neal, Chris J., Nagoshi, Narihito, Rahimi-Movaghar, Vafa, Aarabi, Bizhan, Hofstetter, Christoph P., Wengel, Valerie ter, Nakashima, Hiroaki, Martin, Allan R., Kirshblum, Steven, Rodrigues Pinto, Ricardo, Marco, Rex A. W., Wilson, Jefferson R., Kahn, David E., Newcombe, Virginia F. J., Zipser, Carl M., Douglas, Sam, Kurpad, Shekar N., Lu, Yi, Saigal, Rajiv, Samadani, Uzma, Arnold, Paul M., Hawryluk, Gregory W. J., Skelly, Andrea C., and Kwon, Brian K.

Abstract

Study Design Clinical practice guideline development.Objectives Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that “early” surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI).Methods A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the “evidence-to-recommendation” framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.Results The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2 times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12 months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24 hours compared to after 24 hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24 hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence.Conclusions It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24 hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.

Published
2024
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25. Mortality in ASIA Impairment Scale grade A to D Patients With Odontoid Fracture and Magnetic Resonance Imaging Evidence of Spinal Cord Injury

Author

Aarabi, Bizhan, primary, Neal, Christopher J., additional, Hersh, David S., additional, Harrop, James S., additional, Fehlings, Michael G., additional, Toups, Elizabeth G., additional, Guest, James D., additional, Ugiliweneza, Beatrice, additional, Akhtar-Danesh, Noori, additional, Kurpad, Shekar N., additional, and Grossman, Robert G., additional

Published
2023
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26. Variability in Early Surgery for Acute Cervical Spinal Cord Injury Patients: An Opportunity for Enhanced Care Delivery

Author

Neal, Chris J., primary, Ugiliweneza, Beatrice, additional, Toups, Elizabeth G., additional, Abd-El-Barr, Muhammad, additional, Jimsheleishvili, George, additional, Kurpad, Shekar N., additional, Aarabi, Bizhan, additional, Harrop, James Shields, additional, Shaffrey, Christopher, additional, Fehlings, Michael G, additional, Tator, Charles, additional, Grossman, Robert, additional, and Guest, James, additional

Published
2023
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27. Interhospital Transfer delays care for spinal cord injury patients: A Report from the North American Clinical Trials Network for Spinal Cord Injury

Author

Kelly-Hedrick, Margot, primary, Ugiliweneza, Beatrice, additional, Toups, Elizabeth G., additional, Jimsheleishvili, George, additional, Kurpad, Shekar N., additional, Aarabi, Bizhan, additional, Harrop, James Shields, additional, Foster, Norah, additional, Goodwin, C. Rory, additional, Shaffrey, Christopher, additional, Fehlings, Michael G, additional, Tator, Charles, additional, Guest, James, additional, Neal, Christopher J., additional, Abd-El-Barr, Muhammad, additional, and Williamson, Theresa, additional

Published
2023
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28. 186 A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS)

Author

Fehlings, Michael G., primary, Moghaddamjou, Ali, additional, Harrop, James S., additional, Stanford, Ralph, additional, Ball, Jonathan, additional, Aarabi, Bizhan, additional, Freeman, Brian, additional, Guest, James D., additional, Kurpad, Shekar N., additional, Schuster, James M., additional, Nassr, Ahmad, additional, Schmitt, Karl M., additional, Wilson, Jefferson R., additional, Brodke, Darrel S., additional, Ahmad, Faiz U., additional, Yee, Albert, additional, Ray, Zack, additional, Brooks, Nathaniel P., additional, Wilson, Jason, additional, Kopjar, Branko, additional, and Arnold, Paul M., additional

Published
2023
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29. The bulbocavernosus reflex (BCR) has no prognostic features during the acute evaluation of spinal cord injuries

Author

Mansoor Ali, Daniyal, primary, Sivaganesan, Ahilan, additional, Neal, Christopher J., additional, Thalheimer, Sara, additional, Ugiliweneza, Beatrice, additional, Toups, Elizabeth G., additional, Abd-El-Barr, Muhammad, additional, Jimsheleishvili, George, additional, Kurpad, Shekar N., additional, Aarabi, Bizhan, additional, Shaffrey, Christopher, additional, Fehlings, Michael G, additional, Tator, Charles, additional, Grossman, Robert, additional, Guest, James, additional, and Harrop, James Shields, additional

Published
2023
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30. Mortality in ASIA Impairment Scale grade A to D Patients With Odontoid Fracture and Magnetic Resonance Imaging Evidence of Spinal Cord Injury

Author

Aarabi, Bizhan, Neal, Christopher J, Hersh, David S., Harrop, James S., Fehlings, Michael G., Toups, Elizabeth G., Guest, James D., Ugiliweneza, Beatrice, Akhtar-Danesh, Noori, Kurpad, Shekar N., Grossman, Robert G., Aarabi, Bizhan, Neal, Christopher J, Hersh, David S., Harrop, James S., Fehlings, Michael G., Toups, Elizabeth G., Guest, James D., Ugiliweneza, Beatrice, Akhtar-Danesh, Noori, Kurpad, Shekar N., and Grossman, Robert G.

Abstract

Odontoid fractures are common, often presenting in the elderly after a fall and infrequently associated with traumatic spinal cord injury (tSCI). The goal of this study was to analyze predictors of mortality and neurological outcome when odontoid fractures were associated with signal change on magnetic resonance imaging (MRI) at admission. Over an 18-year period (2001-2019), 33 patients with odontoid fractures and documented tSCI on MRI were identified. Mean age was 65.3 years (standard deviation [SD] = 17.2), and 21 patients were male. The mechanism of injury was falls in 25 patients, motor vehicle accidents in 5, and other causes in 3. Mean Injury Severity Score (ISS) was 40.5 (SD = 30.2), Glasgow Coma Scale (GCS) score was 13 (SD = 3.4), and American Spinal Injury Association (ASIA) motor score (AMS) was 51.6 (SD = 42.7). ASIA Impairment Scale (AIS) grade was A, B, C, and D in 9, 2, 3, and 19 patients, respectively. Mean intramedullary lesion length was 32.3 mm (SD = 18.6). The odontoid peg was displaced ventral or dorsal in 15 patients. Twenty patients had surgical intervention: anterior odontoid screw fixation in 7 and posterior spinal fusion in 13. Eleven (33.3%) patients died in this series: withdrawal of medical care in 5; anoxic brain injury in 4; and failure of critical care management in 2. Univariate logistic regression indicated that GCS score (p<0.014), AMS (p<0.002), AIS grade (p<0.002), and ISS (p<0.009) were risk factors for mortality. Multi-variate regression analysis indicated that only AMS (p<0.002) had a significant relationship with mortality when odontoid fracture was associated with tSCI (odds ratio, 0.963; 95% confidence interval, 0.941–0.986).

Published
2023

35. The Evolving Profile of Acute Spinal Cord Injury Demographics, Outcomes and Surgical Treatment in North America: Analysis of a Prospective Multicenter Dataset of 989 Patients

Author

Vedantam, Aditya, primary, Ugiliweneza, Beatrice, additional, Williamson, Theresa, additional, Guest, James, additional, Harrop, James Shields, additional, Tator, Charles, additional, Aarabi, Bizhan, additional, Fehlings, Michael G, additional, Kurpad, Shekar N., additional, and Neal, Christopher J., additional

Published
2022
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37. Contributors

Author

Abbed, Khalid M., primary, Abdullah, Kalil G., additional, Ackerman, Paul D., additional, Alapan, Yunus, additional, Alentado, Vincent J., additional, Alvin, Matthew D., additional, Ames, Christopher P., additional, Anand, Neel, additional, Anderson, Paul A., additional, Angelov, Lilyana, additional, Anissipour, Alireza K., additional, Anson, John A., additional, Apfelbaum, Ronald I., additional, Archdeacon, Michael, additional, Arnold, Paul M., additional, Arun, Mike W.J., additional, Arzi, Harel, additional, Awad, Ahmed J., additional, Awad, Basem I., additional, Bahuleyan, Biji, additional, Bain, Mark D., additional, Baird, Lissa C., additional, Baisden, Jamie, additional, Baldwin, Nevan G., additional, Ball, Perry A., additional, Balsara, Karl E., additional, Baron, Eli M., additional, Batjer, H. Hunt, additional, Bauer, Andrew M., additional, Bauer, Thomas W., additional, Beckman, Joshua M., additional, Bell, Gordon R., additional, Bellabarba, Carlo, additional, Bennett, E. Emily, additional, Benzel, Edward C., additional, Bergey, Darren L., additional, Bhalla, Tarun, additional, Bierbrauer, Karin S., additional, Bilsky, Mark, additional, Birk, Harjus, additional, Bisson, Erica F., additional, Bono, Christopher, additional, Bransford, Richard J., additional, Brodke, Darrel S., additional, Brooks, Nathaniel, additional, Brotea, Cristian, additional, Brougham, Jared R., additional, Browd, Samuel R., additional, Buckley, Robert T., additional, Burch, Shane, additional, Butler, John, additional, Bydon, Mohamad, additional, Casha, Steven, additional, Ceuppens, Jeroen, additional, Chan, Andrew K., additional, Chen, Thomas C., additional, Cheng, Joseph, additional, Chou, Dean, additional, Choudhri, Tanvir, additional, Clark, Aaron J., additional, Conley, Adam M., additional, Cooper, Paul R., additional, Coric, Domagoj, additional, Corriveau, Mark, additional, Côté, Ian P., additional, Coumans, Jean-Valery C.E., additional, Crawford, Charles H., additional, Curry, William T., additional, Daffner, Scott D., additional, Dalbayrak, Sedat, additional, DeMicco, Russell C., additional, Deutsch, Harel, additional, Dhall, Sanjay S., additional, DiAngelo, Denis J., additional, Dickman, Curtis A., additional, Dodwad, Shah-Nawaz M., additional, Duarte, Siena M., additional, Ebrahim, Zeyd, additional, Eckardt, Gerald W., additional, Ehni, Bruce L., additional, Eichholz, Kurt M., additional, Eichler, Marc, additional, Elbabaa, Samer K., additional, Elder, Benjamin D., additional, Elder, James B., additional, Ellenbogen, Richard G., additional, Epstein, Nancy, additional, Errico, Thomas J., additional, Esquenazi, Yoshua, additional, Fahim, Daniel K., additional, Farag, Ehab, additional, Farley, Chad W., additional, Fehlings, Michael G., additional, Feigenbaum, Frank, additional, Fenton, Eoin, additional, Ferrara, Lisa A., additional, Fessler, R. David, additional, Fessler, Richard G., additional, Finn, Michael A., additional, Finnan, Ryan, additional, Fischgrund, Jeffrey S., additional, Foley, Kevin T., additional, Fontes, Ricardo B.V., additional, Francis, Todd B., additional, Freedman, Brett A., additional, Frost, Frederick, additional, George, John, additional, German, John W., additional, Gerszten, Peter C., additional, Ghobrial, George M., additional, Ghogawala, Zoher, additional, Gibson, Justin L., additional, Gillis, Christopher C., additional, Goel, Vijay K., additional, Goffin, Jan, additional, Gokaslan, Ziya L., additional, Gollogly, Sohrab, additional, Goodwin, C. Rory, additional, Goulart, Carlos R., additional, Goz, Vadim, additional, Gozal, Yair M., additional, Graham, Randall B., additional, Grant, Gerald A., additional, Guan, Jian, additional, Gulec, Ilker, additional, Gussous, Yazeed M., additional, Guyer, Richard D., additional, Gwinn, David, additional, Ha, Sung, additional, Hadar, Eldad, additional, Haldeman, Clayton L., additional, Halim, Alexander Y., additional, Hamilton, Kimberly M., additional, Hammer, Christine L., additional, Hanbali, Fadi, additional, Hann, Shannon W., additional, Harms, Jurgen, additional, Harrop, James S., additional, Hart, Blaine L., additional, Hart, David J., additional, Harwell, Daniel, additional, Hayek, Reyaad A., additional, Heary, Robert F., additional, Henderson, Fraser C., additional, Hitchon, Patrick W., additional, Hoh, Daniel J., additional, Holman, Paul J., additional, Hosono, Noboru, additional, Houseman, Clifford, additional, Houten, John K., additional, Hsieh, Joseph C., additional, Hsu, Wellington K., additional, Huang, Meng, additional, Hurlbert, R. John, additional, Hwang, Lee, additional, Hwang, Steven, additional, İnceoğlu, Serkan, additional, Infinger, Libby Kosnik, additional, de Oliveira, Tatiana von Hertwig Fernandes, additional, Jalan, Devesh, additional, Jha, Neilank, additional, Johnson, J. Patrick, additional, Jones, Charles I., additional, Jones, G. Alexander, additional, Jones, Michael, additional, Juthani, Rupa G., additional, Kager, Christopher D., additional, Kalani, Maziyar A., additional, Kalani, M. Yashar S., additional, Kalfas, Iain H., additional, Kalra, Ricky R., additional, Karimi, Reza J., additional, Kashlan, Osama, additional, Kasliwal, Manish K., additional, Kaul, Vikas, additional, Kaushal, Mayank, additional, Kenning, Tyler J., additional, Khairi, Saad, additional, Khalaf, Tagreed, additional, Khalil, Jad G., additional, Khoo, Larry T., additional, Kiapour, Ali, additional, Kim, Daniel H., additional, Kim, David H., additional, Kimmell, Kristopher T., additional, Kirshblum, Steven, additional, Kitab, Sameer A., additional, Klimo, Paul, additional, Klineberg, Eric O., additional, Koski, Tyler R., additional, Kosztowski, Thomas A., additional, Kowalski, Robert J., additional, Krishnaney, Ajit A., additional, Krupa, Kelly, additional, Krupa, Kristin, additional, Kshettry, Varun R., additional, Kukreja, Sunil, additional, Kuntz, Charles, additional, Kurpad, Shekar N., additional, Kusuma, Srinivasu, additional, LaBagnara, Michael, additional, La Marca, Frank, additional, Laufer, Ilya, additional, Lavelle, Elizabeth Demers, additional, Lavelle, William F., additional, Lawrence, W. Thomas, additional, Lebl, Darren R., additional, Lee, Bryan S., additional, Lee, Sun-Ho, additional, Lenke, Lawrence G., additional, Leon, Steven P., additional, Li, Amy, additional, Li, Yiping, additional, Lieberman, Isador H., additional, Liu, James K.C., additional, Lo, Victor P., additional, Lollis, S. Scott, additional, Lopez-Gonzalez, Miguel, additional, Lubelski, Daniel, additional, Luciano, Mark G., additional, Machado, Andre G., additional, Maddela, Raghu, additional, Madineni, Ravichandra A., additional, Madura, Casey, additional, Maiman, Dennis J., additional, Malone, David G., additional, Mammis, Antonios, additional, Marawar, Satyajit, additional, Marcotte, Nicolas, additional, Maroon, Joseph C., additional, Martin, Michael D., additional, Martinez-del-Campo, Eduardo, additional, Massicotte, Eric M., additional, Mattei, Tobias A., additional, Maurer, Paul K., additional, Mayer, Eric A.K., additional, del Valle, Miguel Mayol, additional, Mazanec, Daniel J., additional, McCormick, Paul C., additional, McCormick, William, additional, Medress, Zachary A., additional, Mendel, Ehud, additional, Metkar, Umesh S., additional, Miele, Vincent J., additional, Mohyeldin, Ahmed, additional, Monsef, Jad Bou, additional, Moore, Timothy A., additional, Morisue, Hikaru, additional, Morone, Peter, additional, Mroz, Thomas E., additional, Mullin, Jeffrey P., additional, Murtagh, F. Reed, additional, Murtagh, Ryan D., additional, Naderi, Sait, additional, Nagaraj, Usha D., additional, Nalley, Charles C., additional, Nanda, Anil, additional, Nasca, Richard J., additional, Nater, Anick, additional, Neal, Matthew T., additional, Nockels, Russ P., additional, Norwig, John A., additional, Ondoma, Solomon M., additional, Oni-Orisan, Akinwunmi, additional, Oren, Jonathan H., additional, Orning, Jennifer, additional, Orr, R. Douglas, additional, Orrico, Katie, additional, Osorio, Joseph A., additional, Otero-Lopez, Ernesto, additional, O'Toole, John, additional, Park, Paul, additional, Parmar, Vikas, additional, Pashman, Robert S., additional, Patel, Rakesh D., additional, Patel, Smruti K., additional, Perez-Cruet, Mick J., additional, Perin, Noel I., additional, Pettigrew, David B., additional, Phillips, H. Westley, additional, Placide, Rick, additional, Porensky, Paul, additional, Prager, Joshua P., additional, Prasad, Srinivas, additional, Prasarn, Mark L., additional, Ramakrishnan, Rakesh, additional, Ramayya, Ashwin G., additional, Rampersaud, Y. Raja, additional, Rasmussen, Peter A., additional, Ratliff, John K., additional, Rauschning, Wolfgang, additional, Rechtine, Glenn R., additional, Recinos, Pablo F., additional, Resnick, Daniel K., additional, Rhee, Jay, additional, Rhines, Laurence D., additional, Riccio, Alexander R., additional, Richardson, Marlin Dustin, additional, Richter, Bertram, additional, Riesenburger, Ron, additional, Riew, K. Daniel, additional, Rogers, Matthew, additional, Saavedra, Fanor M., additional, Safain, Mina G., additional, Saigal, Rajiv, additional, Sawin, Paul D., additional, Scheer, Justin K., additional, Scheidler, Joshua, additional, Schippert, David W., additional, Schlenk, Richard, additional, Schmidt, Bradley, additional, Schmidt, Meic H., additional, Sciubba, Daniel M., additional, Shaffrey, Christopher I., additional, Shaffrey, Mark E., additional, Shah, Anoli, additional, Sharan, Alok, additional, Sharan, Ashwini D., additional, Shedid, Daniel, additional, Shook, Steven, additional, Silverstein, Michael P., additional, Simpson, Venita M., additional, Sin, Anthony, additional, Singh, Harminder, additional, Smith, Donald A., additional, Smith, Gabriel A., additional, Smith, Justin S., additional, Smith, Kyle A., additional, Sonntag, Volker K.H., additional, Soriano-Baron, Hector, additional, Spetzler, Robert F., additional, Spiker, W. Ryan, additional, Staub, Blake, additional, Steinmetz, Michael P., additional, Stillerman, Charles B., additional, Strayer, Andrea, additional, Subramaniam, Gandhivarma, additional, Sukkarieh, Hamdi G., additional, Sumich, Andrew, additional, Sun, Derrick Y., additional, Sunna, Tarek P., additional, Sure, Durga R., additional, Tallarico, Richard A., additional, Tan, Lee A., additional, Tatsui, Claudio E., additional, Techy, Fernando, additional, Theodore, Nicholas, additional, Theologis, Alexander A., additional, Thomas, Nicholas W.M., additional, Thorp, Brian D., additional, Tintle, Scott, additional, Tjoumakaris, Stavropoula, additional, Tobler, William D., additional, Togawa, Daisuke, additional, Traul, David, additional, Traynelis, Vincent C., additional, Tritle, A. Sophia, additional, Trost, Gregory R., additional, Tsai, Eve C., additional, Ugokwe, Kene, additional, Uluc, Kutlauy, additional, Uribe, Juan S., additional, Vaccaro, Alexander R., additional, Valadka, Alex, additional, Vedantam, Aditya, additional, Veeravagu, Anand, additional, Verma, Kushagra, additional, Vitaz, Todd, additional, Voyadzis, Jean-Marc, additional, Wagner, Scott, additional, Wahlquist, Trevor C., additional, Waldrop, Robert, additional, Walsh, Kevin M., additional, Wang, Jeffrey C., additional, Wang, Michael Y., additional, Wang, Patrick T., additional, Ward, John D., additional, Wardak, Zabi, additional, Wathen, Connor, additional, Weinstein, Philip R., additional, Weisman, Michael, additional, Welch, William C., additional, Weller, Simcha J., additional, Westerlund, L. Erik, additional, White, Jonathan A., additional, Whitmore, Robert G., additional, Wilberger, Jack E., additional, Williams, Kim A., additional, Winkler, Ethan A., additional, Witiw, Christopher D., additional, Wolfla, Christopher E., additional, Wolinsky, Jean-Paul, additional, Wong, Cyrus, additional, Woodard, Eric J., additional, Yanamadala, Vijay, additional, Yanni, Daniel S., additional, Yazbak, Philip A., additional, Yen, Chun-Po, additional, Yilmaz, Mesut, additional, Yoganandan, Narayan, additional, Yonemura, Kenneth S., additional, Yonenobu, Kazuo, additional, Yuan, Hansen A., additional, Yue, John K., additional, Zanation, Adam M., additional, Zavarella, Salvatore M., additional, Zeidman, Seth M., additional, Zileli, Mehmet, additional, Zuckerman, Scott, additional, and Zywicke, Holly, additional

Published
2017
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40. We Choose to Call it ‘Degenerative Cervical Myelopathy’: Findings of AO Spine RECODE-DCM, an International and Multi-Stakeholder Partnership to Agree a Standard Unifying Term and Definition for a Disease

Author

Davies, Benjamin M., primary, Khan, Danyal Z, additional, Barzangi, Kara, additional, Ali, Ahmad, additional, Mowforth, Oliver D., additional, Nouri, Aria, additional, Harrop, James S., additional, Aarabi, Bizhan, additional, Rahimi-Movaghar, Vafa, additional, Kurpad, Shekar N, additional, Guest, James D., additional, Tetreault, Lindsay, additional, Kwon, Brian K., additional, Boerger, Timothy F, additional, Rodrigues-Pinto, Ricardo, additional, Furlan, Julio C., additional, Chen, Robert, additional, Zipser, Carl Moritz, additional, Curt, Armin, additional, Milligan, James, additional, Kalsi-Rayn, Sukhivinder, additional, Sarewitz, Ellen, additional, Sadler, Iwan, additional, Widdop, Shirley, additional, Fehlings, Michael G., additional, and Kotter, Mark R.N., additional

Published
2022
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41. Optimizing the Application of Surgery for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 10]

Author

Rodrigues-Pinto, Ricardo, Montenegro, Thiago, Davies, Benjamin M, Kato, So, Kawaguchi, Yoshiharu, Ito, Manabu, Zileli, Mehmet, Kwon, Brian K, Fehlings, Michael G, Koljonen, Paul A, Kurpad, Shekar N, Guest, James D, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Kotter, Mark R N, Harrop, James, Rodrigues-Pinto, Ricardo, Montenegro, Thiago, Davies, Benjamin M, Kato, So, Kawaguchi, Yoshiharu, Ito, Manabu, Zileli, Mehmet, Kwon, Brian K, Fehlings, Michael G, Koljonen, Paul A, Kurpad, Shekar N, Guest, James D, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Kotter, Mark R N, and Harrop, James

Abstract

Study design: Literature Review (Narrative). Objective: To introduce the number 10 research priority for Degenerative Cervical Myelopathy: Individualizing Surgery. Methods: This article summarizes the current recommendations and indications for surgery, including how known prognostic factors such as injury time, age, disease severity, and associated comorbidities impact surgical outcome. It also considers key areas of uncertainty that should be the focus of future research. Results: While a small proportion of conservatively managed patients may remain stable, the majority will deteriorate over time. To date, surgical decompression is the mainstay of treatment, able to halt disease progression and improve neurologic function and quality of life for most patients. Whilst this recognition has led to recommendations on when to offer surgery, there remain many uncertainties including the type of surgery, or timing in milder and/or asymptomatic cases. Their clarification has the potential to transform outcomes, by ensuring surgery offers each individual its maximum benefit. Conclusion: Developing the evidence to better guide surgical decision-making at the individual patient level is a research priority for Degenerative Cervical Myelopathy.

Published
2022

42. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Boerger, Timothy F, Hyngstrom, Allison S, Furlan, Julio C, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, Koljonen, Paul A, Boerger, Timothy F, Hyngstrom, Allison S, Furlan, Julio C, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, and Koljonen, Paul A

Abstract

Study design: Narrative review. Objective: Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. Methods: Literature search. Results: In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. Conclusions: We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

Published
2022

43. Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology.

Author

Gharooni, Aref-Ali, Kwon, Brian K, Fehlings, Michael G, Boerger, Timothy F, Rodrigues-Pinto, Ricardo, Koljonen, Paul Aarne, Kurpad, Shekar N, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, Guest, James D, Gharooni, Aref-Ali, Kwon, Brian K, Fehlings, Michael G, Boerger, Timothy F, Rodrigues-Pinto, Ricardo, Koljonen, Paul Aarne, Kurpad, Shekar N, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, and Guest, James D

Abstract

Study design: Narrative review. Objectives: To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' Methods: A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. Results: Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. Conclusion: There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.

Published
2022

44. James Lind Alliance Priority Setting Partnership for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM]: An Overview of the Methodology Used to Process and Short-List Research Uncertainties

Author

Tetreault, Lindsay, Mowforth, Oliver, Khan, Danyal Z, Gronlund, Toto, Garwood, Philip, Hazenbiller, Olesja, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D, Wilson, Jefferson R, Kwon, Brian K, Fehlings, Michael G, Davies, Benjamin M, Kotter, Mark R N, Tetreault, Lindsay, Mowforth, Oliver, Khan, Danyal Z, Gronlund, Toto, Garwood, Philip, Hazenbiller, Olesja, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D, Wilson, Jefferson R, Kwon, Brian K, Fehlings, Michael G, Davies, Benjamin M, and Kotter, Mark R N

Abstract

Study design: Overview of the methods used for a James Lind Alliance (JLA) Priority Setting Partnership (PSP). Objectives: The objectives of this article are to (i) provide a brief overview of the JLA-facilitated PSP process; (ii) outline how research uncertainties were initially processed in the AO Spine RECODE-DCM PSP; and (iii) delineate the methods for interim prioritization and the priority setting workshop. Methods: A steering group was created to define the scope for the PSP, organize its activities, and establish protocols for decision-making. A survey was created asking what questions on the diagnosis, treatment, and long-term management of DCM should be answered by future research. Results from the survey were sorted into summary questions. Several databases were searched to identify literature that already answered these summary questions. The final list of summary questions was distributed by survey for interim prioritization. Participants were asked to select the top ten most important summary questions. The questions that were ranked the highest were discussed at an in-person consensus workshop. Results: The initial survey yielded a total of 3404 potential research questions. Of the in-scope submissions, 988 were related to diagnosis, 1324 to treatment, and 615 to long-term management of DCM. A total of 76 summary questions were developed to reflect the original submissions. Following a second survey, a list of the top 26 interim priorities was generated and discussed at the in-person priority setting workshop. Conclusions: PSPs enable research priorities to be identified that consider the perspectives and interests of all relevant stakeholders.

Published
2022

45. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Boerger, Timothy F; https://orcid.org/0000-0003-1587-3704, Hyngstrom, Allison S, Furlan, Julio C; https://orcid.org/0000-0002-2038-0018, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Davies, Benjamin M; https://orcid.org/0000-0003-0591-5069, Kotter, Mark R N, Koljonen, Paul A; https://orcid.org/0000-0002-9250-653X, Boerger, Timothy F; https://orcid.org/0000-0003-1587-3704, Hyngstrom, Allison S, Furlan, Julio C; https://orcid.org/0000-0002-2038-0018, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Davies, Benjamin M; https://orcid.org/0000-0003-0591-5069, Kotter, Mark R N, and Koljonen, Paul A; https://orcid.org/0000-0002-9250-653X

Abstract

STUDY DESIGN Narrative review. OBJECTIVE Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. METHODS Literature search. RESULTS In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. CONCLUSIONS We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

Published
2022

48. Supplemental Material - We Choose to Call it ‘Degenerative Cervical Myelopathy’: Findings of AO Spine Research objectives and Common Data Elements Degenerative Cervical Myelopathy, an International and Multi-Stakeholder Partnership to Agree a Standard Unifying Term and Definition for a Disease

Author

Davies, Benjamin M., Khan, Danyal Z, Barzangi, Kara, Ali, Ahmad, Mowforth, Oliver D., Nouri, Aria, Harrop, James S., Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D., Tetreault, Lindsay, Kwon, Brian K., Boerger, Timothy F, Rodrigues-Pinto, Ricardo, Furlan, Julio C., Chen, Robert, Zipser, Carl Moritz, Curt, Armin, Milligan, James, Kalsi-Rayn, Sukhivinder, Sarewitz, Ellen, Sadler, Iwan, Widdop, Shirley, Fehlings, Michael G., and Kotter, Mark R.N.

Subjects
FOS: Clinical medicine, 110323 Surgery, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental Material for We Choose to Call it ‘Degenerative Cervical Myelopathy’: Findings of AO Spine Research objectives and Common Data Elements Degenerative Cervical Myelopathy, an International and Multi-Stakeholder Partnership to Agree a Standard Unifying Term and Definition for a Disease by Benjamin M. Davies, Danyal Z Khan, Kara Barzangi, Ahmad Ali, Oliver D. Mowforth, Aria Nouri, James S. Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, Shekar N Kurpad, James D. Guest, Lindsay Tetreault, Brian K. Kwon, Timothy F Boerger, Ricardo Rodrigues-Pinto, Julio C. Furlan, Robert Chen, Carl Moritz Zipser, Armin Curt, James Milligan, Sukhivinder Kalsi-Rayn, Ellen Sarewitz, Iwan Sadler, Shirley Widdop, Michael G. Fehlings, and Mark R.N. Kotter in Global Spine Journal

Published
2022
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50. Gathering Global Perspectives to Establish the Research Priorities and Minimum Data Sets for Degenerative Cervical Myelopathy:Sampling Strategy of the First Round Consensus Surveys of AO Spine RECODE-DCM

Author

Mowforth, Oliver D, Khan, Danyal Z, Wong, Mei Yin, Pickering, George A E, Dean, Lydia, Magee, Joe, Mullarkey, Laura, Hirayama, Yuri, Rihova, Martina, Butler, Max, Stewart, Max, Goulson, Beth, Ahmed, Shahzaib, Fricke, Kai, Popa-Nimigean, Vladimir, Millar, Zack, Venkatesh, Ashwin, Willison, Alice, Senthil, Keerthi, Hazenbiller, Olesja, Sarewitz, Ellen, Sadler, Iwan, Gronlund, Toto, Tetreault, Lindsay, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D, Wilson, Jefferson R, Kwon, Brian K, Fehlings, Michael G, McNair, Angus G K, Davies, Benjamin M, and Kotter, Mark R N

Subjects
spondylosis, surveys and questionnaires, Orthopedics and Sports Medicine, Surgery, Neurology (clinical), cervical vertebrae, spinal osteophytosis, spinal cord diseases
Abstract

Study Design Survey. Introduction AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (AO Spine RECODE-DCM) is an international initiative that aims to accelerate knowledge discovery and improve outcomes by developing a consensus framework for research. This includes defining the top research priorities, an index term and a minimum data set (core outcome set and core data elements set – core outcome set (COS)/core data elements (CDE)). Objective To describe how perspectives were gathered and report the detailed sampling characteristics. Methods A two-stage, electronic survey was used to gather and seek initial consensus. Perspectives were sought from spinal surgeons, other healthcare professionals and people with degenerative cervical myelopathy (DCM). Participants were allocated to one of two parallel streams: (1) priority setting or (2) minimum dataset. An email campaign was developed to advertise the survey to relevant global stakeholder individuals and organisations. People with DCM were recruited using the international DCM charity Myelopathy.org and its social media channels. A network of global partners was recruited to act as project ambassadors. Data from Google Analytics, MailChimp and Calibrum helped optimise survey dissemination. Results Survey engagement was high amongst the three stakeholder groups: 208 people with DCM, 389 spinal surgeons and 157 other healthcare professionals. Individuals from 76 different countries participated; the United States, United Kingdom and Canada were the most common countries of participants. Conclusion AO Spine RECODE-DCM recruited a diverse and sufficient number of participants for an international PSP and COS/CDE process. Whilst PSP and COS/CDE have been undertaken in other fields, to our knowledge, this is the first time they have been combined in one process.

Published
2021
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