Journal of Neurosurgery: Spine Supplement Explores Therapies for Spinal Cord Injuries

Therapies for Spinal Cord Injury: On the Cutting Edge of Clinical Translation

Newswise CHARLOTTESVILLE, Va. (Aug. 31, 2012) The Journal of Neurosurgery (JNS) Publishing Group is proud to announce publication of the North American Clinical Trials Network (NACTN)/AOSpine North America (AOSNA) Focus Issue on Spinal Cord Injury, a supplement to the September issue of the Journal of Neurosurgery: Spine. Sponsored by AOSpine North America, the supplement is available in print and online, with the online version available free to the public at http://thejns.org/toc/spisup/17/1.

The focus of this special supplement which was spearheaded by Michael Fehlings, MD, PhD, FAANS, Professor of Neurosurgery at the University of Toronto and Medical Director of the Krembil Neuroscience Centre at the Toronto Western Hospital is the development of cutting-edge translational research in the treatment of spinal cord injury (SCI). SCI is an often-devastating injury that affects 2.5 million people worldwide, many of whom are first faced with it in early adulthood. The topic is addressed in a variety of forms in 17 articles and several editorials.

Many of the studies presented in the supplement for the treatment of SCI were conducted by members of the NACTN, a consortium of 10 neurosurgery departments supplemented by a data management center and a pharmacological center. The principal investigator for the NACTN is Robert Grossman, MD, FAANS, Chairman of the Department of Neurosurgery at The Methodist Hospital in Houston. Funded by the Christopher and Dana Reeve Foundation and the U.S. Department of Defense, the NACTN was established to move molecular- and cell-based discoveries in the protection and regeneration of neuronal pathways from the laboratory to the clinical setting.

The supplement brings together papers focused on a variety of subjects related to identifying and evaluating different types of SCI, as well as developing therapeutic strategies for dealing with the disabilities that attend the injury. Graded assessments used to define the scope and extent of injury are presented and reviewed. Clinical and imaging predictors of neurological and functional outcomes, complications, and survival after SCI are identified and assessed. Original clinical studies and review articles on current and potential drug-based therapies are presented. Issues surrounding quality of life in patients with SCI are addressed. The cost-effectiveness of surgery in injured patients is examined and validated. Finally, the goals and progress of the NACTN in the transition of therapeutic strategies from preclinical to clinical settings are described.

Some interesting papers include the following: Clinical prediction model for acute inpatient complications after traumatic cervical spinal cord injury: a subanalysis from the Surgical Timing in Acute Spinal Cord Injury Study by Jefferson Wilson, MD, and colleagues. Although most reports focus on complications occurring during the chronic stages of SCI, these authors set out to create a model to predict the development of acute complications based on clinical variables present at initial hospitalization. The authors found that as older patients aged, high-energy injury mechanism, more severe neurological injury, comorbid illness, and lack of steroid medication were consistent with a greater chance of developing complications during the acute stage of SCI. Riluzole for the treatment of acute traumatic spinal cord injury: rationale for and design of the NACTN Phase I clinical trial by Michael Fehlings, MD, PhD, FAANS, et al. As the title indicates, this paper focuses on riluzole, a benzothiazole drug that conveys neuroprotection by blocking sodium channels and mitigating glutamatergic toxicity. The authors review preclinical and clinical findings on the use of riluzole, describe the Phase I trial, and suggest possible future investigations. Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study by Michael Fehlings, MD, PhD, FAANS, et al. In this paper, the authors examine the cost-effectiveness of this surgery by looking at cost as it relates to the patients gain in quality-adjusted life years. They found an acceptable cost-utility ratio. Translational potential of preclinical trials of neuroprotection through pharmacotherapy for spinal cord injury, by Charles Tator, MD, PhD, MA, FAANS, and others. The focus of this article is on major deficiencies in the movement of pharmacological agents with the potential for providing neuroprotection to the injured spinal cord from preclinical discovery to testing of drug safety and efficacy in the clinical setting. In a detailed study, the authors thoroughly review reports of preclinical testing of glyburide, magnesium sulfate, minocycline, nimodipine and riluzole, and recommend a strategy for creating a new scoring system that could be used to evaluate preclinical results and determine the translational readiness of neuroprotective pharmacological agents.

Spinal cord injuries arise from a two-fold assault. First, there is the initial mechanical injury to the spinal cord, which kills neural cells in the immediate vicinity of the injury, and breaks neuronal pathways between the brain and other parts of the body. Second, there is a cascade of new biochemical, cellular and vascular events that damage axons and lead to the death of previously uninjured neural cells, expanding the area of injury and leading to further neurological compromise. This special supplement to the Journal of Neurosurgery: Spine offers a unique look at current research involving the diagnosis, assessment and treatment of patients with SCI.

NACTN/AOSNA Focus Issue on Spinal Cord Injury, a supplement to the Journal of Neurosurgery: Spine, Volume 17, published September 1, 2012, in print and online (http://thejns.org/toc/spisup/17/1).

Disclosure: AOSpine North America sponsored publication of this supplement to the Journal of Neurosurgery: Spine. Funding for studies described in the supplement was provided by the Christopher and Dana Reeve Foundation and the U.S. Department of Defense among other organizations. Sponsors of individual studies are listed with each article.

For additional information, please contact: Ms. Gillian Shasby, Director of PublicationsOperations Journal of Neurosurgery Publishing Group One Morton Drive, Suite 200 Charlottesville, VA 22903 E-mail: gshasby@thejns.org Telephone (434) 924-5503 Fax (434) 924-5782

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Journal of Neurosurgery: Spine Supplement Explores Therapies for Spinal Cord Injuries