A Clinical Practice Guideline on the Timing of Surgical Decompression and Hemodynamic Management of Acute Spinal Cord Injury and the Prevention, Diagnosis, and Management of Intraoperative Spinal Cord Injury: Introduction, Rationale, and Scope

This initiative aims to develop evidence-based recommendations for the management of both spinal cord injury (SCI) and intraoperative spinal cord injury (ISCI). The lack of consensus surrounding treatments has prevented standardization of care across centers and has created uncertainty with respect to how to best manage patients with SCI. The spinal column should be promptly immobilized with the use of a backboard, rigid cervical collar, and supportive blocks in order to reduce motion of the spine and prevent further damage to the spinal cord. Patients should then be immediately transferred to specialized trauma centers and started on medical therapies that reduce secondary injury and offer neuroprotection. Clinical practice guidelines (CPGs) are statements which include recommendations intended to optimize patient care that are informed by a systematic review of the literature and an assessment of the benefits and harms of alternative options. The main objectives of CPGs are to (i) synthesize and translate the highest quality of evidence into practice recommendations; (ii) optimize treatment outcomes and re-duce the use of any harmful or unnecessary interventions; (iii) establish standard of care and reduce inappropriate practice variations

• 1
  This process resulted in both systematic reviews and clinical practice guidelines/care pathways related to the role and timing of surgery in acute SCI; the optimal hemodynamic management of acute SCI; and the prevention, diagnosis and management of ISCI.
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  The guideline on ISCI is to be used in adolescent or adult patients undergoing spine surgery for any spine-related pathology, including infection, trauma, malignancy, deformity, or degenerative disease.
• 3
  For high-risk patients undergoing spine surgery, intraoperative neurophysiologic monitoring should be employed. Patients at high risk for ISCI during spine surgery should be proactively identified, and multidisciplinary team discussions should be undertaken to manage these patients.