A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope

Abstract

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of magnetic resonance imaging, and the type and timing of rehabilitation. This lack of consensus has prevented the standardization of care across treatment centers and among the various disciplines that encounter patients with SCI. The objective of this guideline is to form evidence-based recommendations for these areas of controversy and outline how to best manage patients with SCI. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care and encouraging clinicians to make evidence-informed decisions.

Heterogeneous emergency department management of published recommendation defined hypotension in patients with acute traumatic spinal cord injury: A multi‐centre overview

“…Fehlings et al provided a series of published clinical practice guidelines in 2017; this did not include any update to the recommendations for the management of hypotension that we have used for reference here. Their stated rationale for this publication series was the lack of standardisation of care across treatment centres internationally preventing best practice and optimal outcomes for all patients with TSCI.…”

Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany

“…However, current standards for disease-specific acute management of SCI have not yet implemented such pathways [9,10]. Moreover, the pathophysiology of SCI-AP is complex.…”

Analysis of surgical treatment results in spinal metastasis

“…Для визначення плану лікування відкриту або пункційну біопсію виконано 21 особі, а 5 хірургічних втручань проведено в терміновому порядку без біопсії з огляду на різко виражену та швидко прогресуючу неврологічну симптоматику. У пацієнтів із початковими проявами неврологічної симптоматики до моменту гістологічного підтвердження діагнозу застосовували глюкокортикоїдні препарати відповідно до Spine Cord Injury Protocol (протокол ураження спинного мозку) [21]. У табл.…”