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?

This article summarizes the key recommendations from the 2023 AO Spine-Praxis guidelines regarding the management of acute spinal cord injury (SCI). It focuses on the timing of surgery, hemodynamic management, and prevention/management of intraoperative SCI. The guidelines emphasize early surgical decompression (within 24 hours) when feasible. They also address the need for more research to define what constitutes sufficient surgical decompression and to assess the impact of early surgery on different types of SCI. The article highlights gaps in knowledge and barriers to implementing the guidelines, especially in underserved areas. It suggests that future research should focus on personalized care approaches for SCI patients.

• 1
  The guidelines strongly recommend surgical decompression within 24 hours of injury when medically feasible, based on evidence showing improved outcomes with early surgery.
• 2
  The guidelines suggest maintaining mean arterial pressure (MAP) between 75-80 mmHg and 90-95 mmHg for 3-7 days post-injury, acknowledging the uncertainty in optimal MAP targets.
• 3
  The guidelines propose a 5-step systematic approach to managing intraoperative spinal cord injury (ISCI), including risk assessment, pre-operative planning, intraoperative management, and postoperative management.