Revised Guidelines for the management of acute cervical spine and spinal cord injuries


Mark Hadley, Charles A and Patsy W Collat professor of Neurological Surgery, UAB Division of Neurological Surgery, Birmingham, Alabama, USA, talks to Spinal News International about new guidelines from the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) on the management of acute cervical spine and spinal cord injuries.

What is scope of the new guidelines and who are they aimed at?


The scope of the guidelines is to be an evidence-based review of, and to hierarchically rank, the science of the diagnosis, assessment, characterisation, and treatment of acute cervical spinal cord and acute cervical spinal traumatic injuries that has been published in the world literature to date.


The guidelines have been designed to serve as a reference source and knowledge bank for acute care providers, emergency room physicians, trauma surgeons, neurological and orthopaedic surgical specialists and rehabilitation physicians who treat patients with these injuries (both in North America and across the globe).


Why did the AANS/CNS decide to revise their existing guidelines (published in 2002)?


Science has advanced, new studies have been accomplished, and technology and techniques have emerged since 2002. It is time to update this medical evidence-based review to capture that new scientific information.


How long has it taken from the decision to revise the guidelines to actually producing the guidelines, and what did the process involve?


It took 18 months from assignment to completion (March 2010 to completion November 2011). The guidelines committee consisted of nine authors (eight neurosurgeons and one orthopaedic surgeon), and they reviewed 15,000 literature citations and wrote 22 texts before they submitted the final draft to the Spine Section Leadership of the Joint Section on Disorders of the Spine and Peripheral Nerves of the AANS/CNS.


What are the biggest changes in the new guidelines compared with the previous guidelines?


We now have 33 additional evidence-based recommendations (109 compared with 76 in 2002). We have created a contemporary scientific compilation of the medical literature to update the 22 topics reviewed in the guidelines. We have condensed four chapter topics into two. We have also included two new topics: electrophysiological monitoring, and cervical spinal injury classification schemes. The former was included because of questions about the use/utility of electrophysiological monitoring during surgery on the cervical spinal cord, for trauma and all other pathology, and the latter was included because clinician scientists have designed injury classification schemes to describe cervical spinal injuries to be used to standardise our classification of traumatic injury patterns/types.


Why, in your view, are the guidelines important?


They are important because they can be used to study contemporary assessment, imaging, and management strategies to define the best and most comprehensive treatment for patients with acute traumatic cervical spine and spinal cord injuries.


At this year’s annual meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (March 7–10, 2012, Orlando, Florida), there is a special course on the revised guidelines. What will be the “take-home” messages about the guidelines for delegates attending the course?


The “take-home” messages are that new updated, comprehensive guidelines are now available, that these guidelines will add to the clinician’s knowledge base, that they are of value to the care of patients with acute traumatic injuries to the cervical spine, and to dispel misconceptions about the use of guidelines in clinical practice (ie, that they are guidelines not “rules”).