A review and update on the current and emerging clinical trials for the acute management of cervical spine and spinal cord injuries - Part III.

INTRODUCTION: Spinal cord injury (SCI) is a debilitating disease with an average annual incidence of 29.5 persons per million worldwide. Hence, it is critical to refine and bolster evidence to inform standards of care and improve outcomes.

EVIDENCE ACQUISITION: In 2013 the American Association of Neurological Surgeons and the Congress of Neurological Surgeons released updated management guidelines for acute cervical spine injuries and SCI; here, we explore cervical SCI treatment trials since the 2013 publication. Of 56 studies published in the Cochrane Library Central Register of Controlled Trials, 19 met inclusion criterion of acute cervical spine injury and are summarized across 4 subcategories: diagnosis, surgical stabilization, scopes/instrumentation, and therapeutic outcomes.

EVIDENCE SYNTHESIS: We confirm the utility of computed tomography for diagnosis, and improved outcomes associated with early (<24 hours) decompressive surgery. We describe advances in laryngoscopy and intubation under various SCI indications. We explore the benefits of continuous positive airway pressure protocols for reducing respiratory insufficiency, and patient education standards for transfer and mobility success. We report on ongoing randomized controlled trials (RCT) for surgical and therapeutic approaches for subpopulations of interest, including incomplete cord lesion, canal stenosis, and riluzole pharmacotherapy. We recommend a large, multicenter, prospective confirmatory RCT to assess the impact of timing of surgery versus conservative management in an effort to generate Class I evidence on the topic.

CONCLUSIONS: Such a study should utilize shared, common variables as outlined by the National Institutes of Health SCI Common Data Elements to enable international collaboration and data pooling for robust, reproducible analyses.