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? Article Swipe
Michael G. Fehlings
,
Ali Moghaddamjou
,
Nathan Evaniew
,
Lindsay Tetreault
,
Mohammed Ali Alvi
,
Andrea C. Skelly
,
Brian K. Kwon
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1177/21925682231196825
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1177/21925682231196825
Study Design Narrative summary of the 2023 AO Spine-Praxis clinical practice guidelines for management in acute spinal cord injury (SCI). Objectives The objective of this article is to summarize the key findings of the clinical practice guidelines for the optimal management of traumatic and intraoperative SCI (ISCI). This article will also highlight potential knowledge translation opportunities for each recommendation and discuss important knowledge gaps and areas of future research. Methods Systematic reviews were conducted according to accepted methodological standards to evaluate the current body of evidence and inform the guideline development process. The summarized evidence was reviewed by a multidisciplinary guidelines development group that consisted of international multidisciplinary stakeholders. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of the evidence for each critical outcome and the “evidence to recommendation” framework was used to formulate the final recommendations. Results The key recommendations regarding the timing of surgical decompression, hemodynamic management, and the prevention, diagnosis, and management of ISCI are summarized. While a strong recommendation was made for early surgery, further prospective research is required to define what constitutes sufficient surgical decompression, examine the role of ultra-early surgery, and assess the impact of early surgery in different SCI phenotypes, including central cord syndrome. Furthermore, additional investigation is required to evaluate the impact of mean arterial blood pressure targets on neurological recovery and to determine the utility of spinal cord perfusion pressure measurements. Finally, there is a need to examine the role of neuroprotective agents for the treatment of ISCI and to prospectively validate the new AO Spine-Praxis care pathway for the prevention, diagnosis, and management of ISCI. To optimize the translation of these guidelines into practice, important barriers to their implementation, particularly in underserved areas, need to be explored. Ultimately, these recommendations will help to establish more personalized approaches to care for SCI patients. Conclusions The recommendations from the 2023 AO Spine-Praxis guidelines not only highlight the current best practice in the management of SCI, but reveal critical knowledge gaps and barriers to implementation that will help to guide further research efforts in SCI.
Related Topics
Concepts
Medicine
Spinal cord injury
Multidisciplinary approach
Grading (engineering)
Guideline
Intensive care medicine
Systematic review
Knowledge translation
Decompression
Evidence-based medicine
Physical therapy
MEDLINE
Surgery
Spinal cord
Alternative medicine
Psychiatry
Political science
Horticulture
Pathology
Law
Civil engineering
Sociology
Social science
Engineering
Biology
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1177/21925682231196825
- https://journals.sagepub.com/doi/pdf/10.1177/21925682231196825
- OA Status
- gold
- Cited By
- 16
- References
- 49
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4393143560
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4393143560Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1177/21925682231196825Digital Object Identifier
- Title
-
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?Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-03-01Full publication date if available
- Authors
-
Michael G. Fehlings, Ali Moghaddamjou, Nathan Evaniew, Lindsay Tetreault, Mohammed Ali Alvi, Andrea C. Skelly, Brian K. KwonList of authors in order
- Landing page
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https://doi.org/10.1177/21925682231196825Publisher landing page
- PDF URL
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https://journals.sagepub.com/doi/pdf/10.1177/21925682231196825Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
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https://journals.sagepub.com/doi/pdf/10.1177/21925682231196825Direct OA link when available
- Concepts
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Medicine, Spinal cord injury, Multidisciplinary approach, Grading (engineering), Guideline, Intensive care medicine, Systematic review, Knowledge translation, Decompression, Evidence-based medicine, Physical therapy, MEDLINE, Surgery, Spinal cord, Alternative medicine, Psychiatry, Political science, Horticulture, Pathology, Law, Civil engineering, Sociology, Social science, Engineering, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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16Total citation count in OpenAlex
- Citations by year (recent)
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2025: 13, 2024: 3Per-year citation counts (last 5 years)
- References (count)
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49Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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