AO Spine Clinical Practice Recommendations for Adjunctive Medical Therapies in Acute Traumatic Spinal Cord Injury: Contemporary Concepts

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Abstract
Study Design: Review of the literature with critical appraisal and clinical recommendations. Objective: To highlight contemporary concepts involving adjunctive medical and non-surgical therapies in the management of acute traumatic spinal cord injury (tSCI) that may be integrated into clinical practice. Methods: Three recent articles relating to the management of acute tSCI were selected and critically appraised. Clinical practice recommendations were developed and evaluated using the GRADE criteria. Results: Article 1: A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on Hemodynamic Management. Conditional recommendation to augment mean arterial blood pressure to at least 75-80 mmHg but not higher than 90-95 mmHg for a duration of 3-7 days to optimize spinal cord perfusion in acute tSCI. Article 2: Spinal Cord Perfusion Pressure Predicts Neurologic Recovery in Acute Spinal Cord Injury. No recommendation can be made at this time in the utilization of SCPP-guided hemodynamic management as an adjunctive strategy in the acute care of tSCI. Article 3: Safety and Efficacy of Riluzole in Acute Spinal Cord Injury Study (RISCIS). No recommendation can currently be made on the routine use of riluzole to patients with acute cervical tSCI. Conclusions: The management of tSCI extends beyond the operating room. The development of emerging medical and non-surgical treatments to augment timely and adequate decompression requires critical consideration as new data becomes available. While some topics do not have the scientific backing to be able to make a recommendation at this time, they point towards areas of future study.

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