Knowledge Forum SCI –

building on world-wide partnerships for global impact

The AOSpine Knowledge Forum Spinal Cord Injury (KFSCI) can pride itself upon a significant number of firsts, both in its studies and in their outcomes. KFSCI is also the only spinal cord injury group in the AO. Soon its accomplishments may extend to yet a new level, moving from knowledge creation to knowledge transfer, from dissemination to implementation.

 

The KFSCI story can be traced to the very beginning of the Knowledge Forums, but the history of their studies started long before. Thinking back, Chairperson Michael Fehlings remembers the creation of the AO Clinical Divisions, how the AOSpine Regions were set up; he vividly recalls the excitement of interdisciplinary broadening when he came onboard as a young neurosurgeon – all building up to the AOSpine Research structure, and the birth of the KFSCI.

 

"By then we had established a significant research infrastructure in North America, and we had a vision of doing multi-centered clinical research studies." "We had a vision … what followed meant stepping into an area completely novel to the AO: an international multi-center randomized controlled trial on a drug."This is exactly what the KFSCI went on to do. Initially, the Knowledge Forum Trauma and SCI was launched as one study group. The groups are still working closely together, as Steering Committee member Bizhan Aarabi testifies, but a separation allowed to sharpen the focus. KF Trauma went on to develop Classifications, for KFSCI it meant building on an earlier study showing early surgical intervention had a positive impact on improving neurological outcomes and reducing complications for people with spinal cord injury.

 

Brave new undertakings

What followed meant stepping into an area completely novel to the AO: an international multi-center randomized controlled trial on a drug, complementing early surgical intervention, to improve outcomes in spinal cord injury. "Through systematic reviews, we decided to focus on Riluzole, a repurposing of an inexpensive drug, approved for reducing neurological deterioration in Amyotrophic Lateral Sclerosis, ALS", Fehlings explains.

 

At the time, AOSpine started encouraging partnering with other organizations. KFSCI quickly established strategic partnerships (*) while making use of the strengths of AOSpine North America. The clinical trial for Riluzole showed promising results, and in collaboration with other groups, the KFSCI launched the RISCIS trial. "This would have been a major undertaking by any measure. "The guidelines findings will make life essentially easier for spine surgeons!" – "It is really exciting to think that the work we are doing could have a global impact!"For the AO, it was the first ever large multi-center randomized controlled trial", Fehlings is proud to say. Currently, the study involves 20 sites, a hundred enrolled patients, and the plan is to reach the enrollment target in three years. Aarabi is excited the outcomes will have direct implications on patient care, if with the effect from the medication you do not have to wait months to see clinical evidence for recovery of functions. "Ours is a rigorous but a very specialized group. Spinal cord injury is rare, but the chances of recovery really should encourage centers to participate in studies."

 

Another big area for KFSCI is the development of clinical practice guidelines and knowledge translation. "We felt that there were big knowledge gaps around the management of traumatic and non-traumatic SCIs, a condition called degenerative cervical myelopathy", Fehlings explains. A several-year undertaking of the KFSCI Guidelines Group with a broad range of partnerships (**) recently published results in an open access Focus Issue in the Global Spine Journal. The guideline indicates that patients with acute spinal cord injury should undergo early surgical intervention when medically feasible, and that surgery is the treatment of choice for patients with a more severe myelopathy. "But there is still some uncertainty how best to manage patients with mild myelopathy. So, we also defined critical knowledge gaps that will represent areas of research in the future."

 

Michael Fehlings and Luiz Vialle moderate. The first ever KF sessions at the Global Spine Conference 2011 in Barcelona were attended by 300 people.KFSCI Steering Committee members James Harrop, Shekar Kurpad, Robert Grossman, Michael Fehlings, Bizhan Aarabi, and Brian Kwon (Toronto, ON, Canada, 2015).An extended KFSCI Steering Committee meeting in Milan, Italy, 2017. From left to right: Jeff Wilson (associate member), Vafa Rahimi-Movaghar (AOSpine Research Commission member, representing Middle East), Mark Kotter, Shekar Kurpad, James Harrop, Brian Kwon. Front row: Bizhan Aarabi, Knowledge Forum Manager María Alvarez Sánchez, Chairperson Michael Fehlings and KF Trauma Chairperson Cumhur Oner.Launching NACTN collaboration at the RISCIS study group working meeting (Toronto, ON, Canada, 2015).3 - 4<>

Science in motion

If Bizhan Aarabi is right, the guidelines findings will make life essentially easier for spine surgeons. The KFSCI is keen to move forward in knowledge translation and disseminate the new information to everyone involved in the "Through our work, I'd like to see changes in clinical practice with improved clinical outcomes, potentially changes in society with better access to care."care of people with cervical myelopathy and spinal cord injury. To alter care, the KFSCI wants to "test drive" the guidelines, and Fehlings would like to see enhanced interaction between education, community development and the area of new technology development in the AO. "It all fits wonderfully to the AO principles as part of the knowledge to action cycle: the community defines the key questions, the researchers come up with solutions, you distill and synthesize the knowledge, disseminate it to the community, and so on."

 

Overall, Fehlings sees globalization of research as an extremely positive opportunity. It can widen perspectives on certain conditions and set the stage for impact on a world-wide level. "It is really exciting to think that the work we are doing could have a global impact! We could tailor the guidelines to work in countries with advanced infrastructure, but also in emerging economies where the infrastructure is more challenged."

 

Jefferson Wilson also commends the international presence and perspective in the AO, which allows for a more global picture of the actual disease, injury, or clinical epidemiology. "There is an enthusiasm in the AO to get the job done, to make good studies happen, and put personal glory aside", Wilson continues. He is one of the selected young surgeons to have been invited as associate members into the Knowledge Forums. So far, he is the only associate in KFCSCI, but he hopes to see continued collaborations from participants in all stages of their career.

 

New generations stepping in

The past two years Wilson has participated in regular discussions with great knowledge experts in the KFSCI, fulfilling his goal of becoming a surgeon scientist in spinal trauma. "It's really exciting, this is such a rich collaborative environment! I am trying to gain as much wisdom from this group as I possibly can." Wilson points out that the spinal cord injury patient population is getting bigger and more heterogeneous: the biggest groups affected are no longer young people from motor vehicle accidents or sports injuries, but elderly people with incomplete spinal cord injuries from falls. "Besides looking at changing epidemiology we should derive preventative strategies and specific treatment strategies for the new populations", Wilson thinks. "I've already reached some of my goals. I suppose I'll spend the rest of my career trying to answer these questions."

 

Discoveries and break-throughs are hard to come across in complex spinal cord injury. But with time, the KFSCI trusts they can point to a body of research that has made a difference for human beings with various spinal conditions, including spine trauma and spinal cord injury. "I'd like to see changes in clinical practice with improved clinical outcomes, potentially changes in society with better access to care", Fehlings envisions, always thinking of the generations to come. "I'd also like to look at the number of people we've trained or mentored as fellows, as young faculty, and associates, and to see succession that occurs where young leaders are being developed."

 

QUICK FACTS:

  • "Burning issues in the treatment of spinal cord injuries–how can AOSpine contribute to improve patients' lives?" A workshop attended by 300 people at the Global Spine Congress 2011, Barcelona, confirmed interest in topic
  • KF Trauma and SCI launched in 2011, co-chaired by Michael Fehlings and Alexander Vaccaro
  • KFSCI starts operating as an independent study group from 2015
  • Chairperson Michael Fehlings leads a Steering Committee of 6 members; serves as a member of the AOSpine International Research Commission
  • Associate member structure in development, will provide wider regional representation
  • Published 22 peer-reviewed journal articles and 18 presentations
  • AOSpine Master Series, Volume 7, 2015
  • AOSpine Master Series, Volume 8, 2017

 

STUDY HIGHLIGHTS:

  • RISCIS (*) – ongoing AOSpine International study in partnership with AOSpine North America, the North American Clinical Trials Network (NACTN), Christopher and Dana Reeves Foundation, US Department of Defense, AOSpine International and North America, Ontario Neurotrauma Foundation, Rick Hansen Institute
  • SCI Database Merge – merging two existing databases NACTN and STASCIS
  • SCI Guidelines (**) – developed by KFSCI in partnership with AOSpine North America, the Cervical Spine Research Society (CSRS), the Joint Section Neuro-Trauma and Critical Care from the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons, AOSpine International and North America, NACTN, Christopher and Dana Reeve Foundation; the Guidelines Group brought together representatives from around the word, nurses, orthopedic surgeons, ICU and Emergency Room doctors, rehabilitation specialists, physiotherapists, people with spinal cord injury and NGOs representing them, pre-clinical and clinical epidemiology scientist

Read more on the Guidelines at

  aospine.aofoundation.org

 

Access the Guidelines here

  journals.sagepub.com

 

For more information KFSCI see

  www.aospine.org/kf-sci

 

For more information on RISCIS see

  www.clinicaltrials.gov

 

This article is part of a series on the AOSpine Knowledge Forums, running since AOSpine Newsletter Issue 11. Upcoming issues will showcase more KFs and their most important study projects.

 

 

Newsletter 14 | December 2017

Newsletter 14 December 2017

AOSpine

www.aospine.com | info@aospine.org

 

Copyright © 2017 AO Foundation.
All rights reserved.