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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article provides an introduction to AOSpine and the AOSpine Knowledge Forums including the new AOSpine thoracolumbar fracture classification system. Other topics include how the timing of surgical intervention affects safety, neurologic outcomes, and cost-effectiveness, as well as neuroprotective benefits of using the sodium channel blocker riluzole after primary spinal cord injury.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETrauma\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETrauma\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMichael P. Grevitt, MD, Nottingham University Hospital, Nottingham, United Kingdom, opened the session with an introduction to AOSpine and the AOSpine Knowledge Forums.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAOSpine is an international community of spine surgeons generating, distributing, and exchanging knowledge to advance science and the spine care profession through research, education, and community development [AO Foundation. \u003Ca href=\u0022https:\/\/www.aofoundation.org\/Structure\/Pages\/default.aspx\u0022\u003Ehttps:\/\/www.aofoundation.org\/Structure\/Pages\/default.aspx\u003C\/a\u003E. Accessed November 25, 2014]. The AOSpine Knowledge Forums are focused working groups acting to foster innovation and evidence-based clinical practice in all pathologies, including tumor, deformity, spinal cord injury (SCI) and trauma, and degenerative and biologics. A steering committee of up to 10 international spine experts governs each forum. \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E provides an update on the status and achievements of each forum.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15391\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15391\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15391\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003E2014 Status and Achievements of the AOSpine Knowledge Forums\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ECarlo Bellabarba, MD, University of Washington, Seattle, Washington, USA, discussed the new AOSpine thoracolumbar fracture classification system [Vaccaro AR et al. \u003Cem\u003ESpine (Phila Pa 1976)\u003C\/em\u003E. 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThoracolumbar fracture classification assists in teaching, provides a way to communicate the relative severity of the injury, and offers a conceptual framework for diagnosis and treatment. A good classification system must be functional, practical, and reproducible. In the spine, there are 4 anatomic regions of interest: the occipitocervical junction (C0 to C2), for which there is no unifying concept at this time; the subaxial region (C3 to C7), for which, again, there is no universally accepted system; the thoracic and lumbar regions, which have the best systemic approaches; and the sacrum, which is usually a part of pelvic injuries.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe Magerl-AO classification system was developed in 1994. While it has many good points, it was designed primarily for thoracic and lumbar injuries. The purpose of the new system is to make the scheme applicable throughout the entire spine, to improve hierarchical consistency, and to improve the ability to guide treatment.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ERadiographic or presumed mechanical information is not always sufficient to make a diagnosis. A new AO Foundation classification was needed to achieve global acceptance, resolve hierarchical inconsistencies, integrate neurologic exam and modifiers for specific conditions, and integrate with a severity scoring system. The revised classification and injury severity system is based on the evaluation of morphologic classification of the fracture, neurologic injury, and clinical modifiers.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EMorphologic classification is divided into types A, B, and C. Type A covers failure of anterior compression fractures with intact tension band injuries and includes 5 subtypes: inconsequential process fractures, wedge compression, splits, incomplete burst, and complete burst. Type B is a failure of the posterior or anterior tension band and includes 3 subtypes: a monosegmental bony failure of the tension band, a bony and\/or ligamentous failure of the tension band with a type A fracture, and an injury through the disk or vertebral body leading to a hyperextended position of the spinal column. Type C is failure of all elements, leading to dislocation or displacement, and has no subtypes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe grading system for neurologic status has 6 subtypes\u2014described as neurologically intact, transient neurologic deficit, radicular symptoms, incomplete SCI, complete SCI, and unknown status. Patient-specific clinical modifiers include fractures with indeterminate injury to posterior tension band based on spinal imaging, with or without magnetic resonance imaging (MRI; M1), and patient-specific comorbidity that may dictate type of treatment (M2). In summary, the new classification system combines the evaluation of morphology, neurology, and modifiers into a scoring scheme that will help guide treatment and predict outcome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003ENew evidence regarding the timing of surgery and the outcomes for acute SCI is encouraging. Michael G. Fehlings, MD, PhD, University of Toronto, Toronto, Ontario, Canada, discussed how the timing of surgical intervention affects safety, neurologic outcomes, and cost-effectiveness. Starting from the primary injury (compression\/contusion, bone\/disc displacement, or fracture\/dislocation), Prof Fehlings examined the findings for timing of decompression, outcomes, safety, and the neuroprotective benefits of sodium channel blockers.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EA meta-analysis of 14 preclinical and 22 clinical studies concluded that early surgical decompression (within 24 to 72 hours after injury) is safe and feasible, improves clinical and neurologic outcomes, and reduces hospital stay, health care costs, and pulmonary complications [Furlan JC et al. \u003Cem\u003EJ Neurotrauma\u003C\/em\u003E. 2011]. Another preclinical meta-analysis confirmed this finding and suggested that early decompression improves neurobehavioral deficits in animal models of SCI [Batchelor PE et al. \u003Cem\u003EPLoS One\u003C\/em\u003E. 2013]. In a systematic review and meta-analysis of 18 studies, investigators found a significant association with improved neurologic and length-of-stay outcomes for early decompression [van Middendorp JJ et al. \u003Cem\u003EJ Neurotrauma\u003C\/em\u003E. 2013]. However, the findings were seen as less robust than those reported in other meta-analyses, resulting from different sources of heterogeneity within and among original studies.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EIn the prospective STASCIS study [Fehlings MG et al. \u003Cem\u003EPLoS One\u003C\/em\u003E. 2012] of 313 patients, Prof Fehlings analyzed the effect of timing of decompression on SCI outcome. In the comparison of early (\u0026lt; 24 hours after injury) and delayed (\u2265 24 hours) decompression surgery for traumatic cervical SCI, the odds of having an American Spinal Injury Association (ASIA) impairment scale improvement of \u2265 2 grades were 2.8 times higher among patients who underwent early surgery compared with those who underwent late surgery (OR, 2.83; 95% CI, 1.10 to 7.28; \u003Cem\u003EP\u003C\/em\u003E = .03) at 6-month follow-up. Higher complication rates were seen in the late group (46%) compared with the early group (36%) mainly in the area of ventilator-associated pneumonia. These findings were supported by a Canadian study [Wilson JR et al. \u003Cem\u003ESpinal Cord\u003C\/em\u003E. 2012]. O\u0027Boynick and colleagues [\u003Cem\u003ENeurosurg Focus\u003C\/em\u003E. 2014] reported a savings of $80 000 per patient with early treatment of thoracolumbar spine fractures.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EA model to predict outcome after SCI surgery has been developed that relates acute clinical imaging information to functional outcome at 1 year [Wilson JR et al. \u003Cem\u003EJ Neurotrauma\u003C\/em\u003E. 2012]. The model uses age, American Spinal Injury grade, and ASIA motor score at admission, and MRI results to produce a functional independence score.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EProf Fehlings discussed the neuroprotective benefits of using the sodium channel blocker riluzole after primary SCI. Following SCI, cellular swelling occurs, followed by an influx of calcium that triggers pathologic glutamatergic release. When administered shortly after injury, riluzole inhibits the release of glutamic acid from neurons and spares them from secondary damage. In a recent prospective multicenter phase 1 trial [Grossman RG et al. \u003Cem\u003EJ Neurotrauma\u003C\/em\u003E. 2014], patients (n = 36) with ASIA impairment scale, grades A-C, treated with riluzole (50 mg, BID) within 12 hours of SCI for 14 days had more robust conversions of impairment grades to higher grades than a comparison group. A phase 3 study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01597518\u0026amp;atom=%2Fspmdc%2F14%2F50%2F28.atom\u0022\u003ENCT01597518\u003C\/a\u003E] with riluzole is ongoing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003ECurrent data on the role and timing of surgical intervention shows that early intervention is safe, can improve neurological outcomes, and is cost-effective. Recent data showing that riluzole may improve lower extremity motor scores are promising.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/50\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzltkd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzltkd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}