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. 2024 Mar;14(2):546-560.
doi: 10.1177/21925682221116888. Epub 2022 Aug 29.

Current Practice of Acute Spinal Cord Injury Management: A Global Survey of Members from the AO Spine

Nader Hejrati  1   2 , Ali Moghaddamjou  1   2   3 , Karlo Pedro  2 , Mohammed Ali Alvi  3 , James S Harrop  4 , James D Guest  5 , Brian K Kwon  6 , Michael G Fehlings  1   2   3
Affiliations

Current Practice of Acute Spinal Cord Injury Management: A Global Survey of Members from the AO Spine

Nader Hejrati et al. Global Spine J. 2024 Mar.

Abstract

Study design: Cross-sectional, international survey.

Objectives: To examine current international practices as well as knowledge, adoption, and barriers to guideline implementation for acute spinal cord injury (SCI) management.

Methods: A survey was distributed to members of AO Spine. The questionnaire was structured to obtain demographic data and preferred acute SCI practices surrounding steroid use, hemodynamic management, and timing of surgical decompression.

Results: 593 members completed the survey including orthopaedic surgeons (54.3%), neurosurgeons (35.6%), and traumatologists (8.4%). Most (61.2%) respondents were from low and middle-income countries (LMICs). 53.6% of physicians used steroids for the treatment of acute SCIs. Respondents from LMICs were more likely to administer steroids than HICs (178 vs. 78; P < .001). 331 respondents (81.5%) answered that patients would receive mean arterial pressure (MAP) targeted treatment. In LMICs, SCI patients were less likely to be provided with MAP-targeted treatment (76.9%) as compared to HICs (89%; P < .05). The majority of respondents (87.8%) reported that patients would benefit from early decompression. Despite overwhelming evidence and surgeons' responses that would offer early surgery, 62.4% of respondents stated they encounter logistical barriers in their institutions. This was particularly evident in LMICs, where 57.9% of respondents indicated that early intervention was unlikely to be accomplished, while only 21.1% of respondents from HICs stated the same (P < .001).

Conclusion: This survey highlights challenges in the implementation of standardized global practices in the management of acute SCI. Future research efforts will need to refine SCI guidelines and address barriers to guideline implementation.

Keywords: guideline implementation; hemodynamic management; spinal cord injury; steroid use; timing of surgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Heat map showing the geographic distribution of the respondents (n = 593).
Figure 2.
Figure 2.
A) Bar plot showing the responses for steroid administration by American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade (Y-axis represents raw numbers). B) Bar plot showing the responses for steroid administration by level of injury (Y-axis represents raw numbers).
Figure 3.
Figure 3.
Likert Plot showing the perceived importance of factors impacting decision-making for early surgical intervention for patients with acute spinal cord injury.
See this image and copyright information in PMC

References

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