Neural Repair and Regeneration after Spinal Cord Injury and Spine Trauma

Table of Contents

1. Anatomy (touch on both spine trauma and SCI) 2. Epidemiology 3. Classification Systems: Spine Trauma 4. Classification Systems: SCI 5. Outcome Measures 6. Imaging: Spine Trauma 7. Imaging: SCI (include advanced imaging techniques) 8. Intraoperative imaging and Image Guidance 9. Spine Trauma Management Issues: Upper C-spine 10. Spine Trauma Management Issues: C-spine 11. Spine Trauma Management Issues: Thoracic and Lumbar 12. Spine Trauma Management Issues: Sacrum 13. Spine Trauma Management Issues: Polytrauma 14. Spine Trauma Management Issues: Geriatric 15. Spine Trauma- areas of controversy and emerging concepts 16. Traumatic Central Cord Injury 17. SCI Management: Pathophysiology 18. SCI Management: Role and Timing of Surgical Intervention 19. SCI Management: ICU Management (including MPSS) + Drugs 20. SCI Management: Rehabilitation 21. SCI Management: Economic Impact 22. Complications 23. Neurochemical Biomarkers of Acute Spinal Cord Injury 24. Clinical Trials: Drugs 25. Clinical Trials: Regenerative Approaches 26. Clinical Trials: Rehabilitation Approaches 27. Translational Perspective: Neuroprotective Strategies for Traumatic Spinal Cord Injury 28. Translational Perspective: Neuroregenerative Strategies for Traumatic Spinal Cord Injury 29. Emerging Concepts in the clinical management of SCI for the future 30. Translational Research in Spinal Cord Injury: What is in the Future?

Authors

Michael Fehlings Robert Campeau Family Foundation-Dr. CH Tator Chair in Brain and Spinal Cord Research. Dr. Fehlings is the Vice Chair Research for the Department of Surgery at the University of Toronto and Head of the Spinal Program at Toronto Western Hospital, University Health Network. Dr. Fehlings is a Professor of Neurosurgery at the University of Toronto, holds the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration, is a Scientist at the McEwen Centre for Regenerative Medicine and a McLaughlin Scholar in Molecular Medicine. In the fall of 2008, Dr. Fehlings was appointed the inaugural Director of the University of Toronto Neuroscience Program (which he held until June 2012) and is currently Co-Director of the University of Toronto Spine Program. Dr. Fehlings combines an active clinical practice in complex spinal surgery with a translationally oriented research program focused on discovering novel treatments to improve functional outcomes following spinal cord injury (SCI). He has published over 850 peer-reviewed articles (h-index 87) chiefly in the area of central nervous system injury and complex spinal surgery. His seminal 1991 paper, cited over 1400 times, outlined the severe and lasting consequences of SCI due to a cascade of secondary injury mechanisms following the initial trauma. His research on secondary injury mechanisms ultimately led to the commencement of the multicenter, international Surgical Timing in Acute Spinal Cord Injury Study (STASCIS), aimed at establishing the need for early surgical decompression to prevent the negative effects of the secondary injury cascade. The results from this study, led by Dr. Fehlings and published in 2012, demonstrated the critical importance of early surgical decompression (< 24 hours) to improve functional and neurological outcomes, and reduce secondary complications in individuals with SCI. His work examining the use of regenerative approaches including neural stem cells to repair the injured nervous system has led to numerous international awards and has helped lead the field toward clinical translation in this area. In 2017, the initiative to create Clinical Practice Guidelines for the management of degenerative cervical myelopathy and acute traumatic SCI - a multi-disciplinary international effort led by Dr. Fehlings - was published in the Global Spine Journal. Most recently, Dr. Fehlings' work demonstrating that midcervical excitatory interneurons are essential for the maintenance of breathing in non-traumatic cervical SCI and critical for promoting respiratory recovery after traumatic SCI was published in Nature. Dr. Michael Fehlings has received numerous prestigious awards including the Gold Medal in Surgery from the Royal College of Physicians and Surgeons (1996), nomination to the Who's Who list of the 1000 most influential scientists of the 21st century (2001), the Lister Award in Surgical Research (2006), the Leon Wiltse Award from the North American Spine Society for excellence in leadership and/or clinical research in spine care (2009), the Olivecrona Award (2009) -- the top award internationally for neurosurgeons and neuroscientists awarded by the Nobel Institute at the Karolinska Institute in Stockholm for his important contributions in CNS injury repair and regeneration, the Reeve-Irvine Research Medal in Spinal Cord Injury (2012), the Golden Axon Leadership Award (2012), the Mac Keith Basic Science Lectureship Award for significant contributions to the basic science of cerebral palsy and childhood onset disabilities (2012), and was the Mayfield Lecturer (2012). In 2012, Dr. Fehlings served as the 40th President of the Cervical Spine Research Society (CSRS) -- the only Canadian to do so -- and was honoured with the CSRS Presidential Medallion for outstanding leadership and contributions to cervical spine research. In 2013, Dr. Fehlings was honoured with the Queen Elizabeth II Diamond Jubilee Medal presented to him by the Honourable Stephen Harper, the H. Richard Winn Prize from the Society of Neurological Surgeons, the Jonas Salk Award for Scientific Achievements from the March of Dimes Canada and the Henry Farfan Award from the North American Spine Society. In 2014, Dr. Fehlings was elected to the Fellowship of the Royal Society of Canada and to the Canadian Academy of Health Sciences, and in 2016 won the Royal College of Physicians and Surgeons Mentor of the Year Award. Brian Kwon Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada. Dr. Kwon is a surgeon-scientist with advanced training in spine surgery and also a PhD in neuroscience. He is a Professor in the UBC Department of Orthopaedics. As an attending orthopaedic spine surgeon at Vancouver General Hospital his practice is focused on the management of adult spine trauma, spinal cord injuries, and non-traumatic conditions such as spine infection, deformity, and degeneration. As a neuroscientist and Principal Investigator at ICORD, Dr. Kwon runs an active basic/translational research laboratory. Dr. Kwon is currently also serving as the Associate Director, Clinical Research, for ICORD, and is the Associate Scientific Director of the Rick Hansen Institute. Alexander R. Vaccaro Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery, Professor of Neurosurgery, Sidney Kimmel Medical Center of Thomas Jefferson University, Co-Director, Delaware Valley Spinal Cord Injury Center, President, Rothman Orthopaedics, Philadelphia, Pennsylvania. Dr. Vaccaro has served as the president of Rothman Orthopaedics since 2014 and is the Richard H. Rothman Professor and Chairman in the Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University in Philadelphia, Pennsylvania. He was the recipient of the Leon Wiltse award given for excellence in leadership and clinical research for spine care by the North American Spine Society (NASS) and is the past President of Cervical Spine Research Society (CSRS), the American Spinal Injury Association and the Association for Collaborative Spine Research. He is currently a member of the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors.

He has over 900 peer-reviewed and 200 non-peer reviewed publications. He has published over 372 book chapters and is the editor of over 63 textbooks and co-editor of OKU-Spine I and editor of OKU-8. Dr. Vaccaro also serves as Co-Director of the Regional Spinal Cord Injury Center of the Delaware Valley. F. Cumhur Oner University Medical Centre Utrecht, Utrecht, The Netherlands. Cumhur �ner obtained in 1980 his Medical Degree in Ankara, Turkey and did his orthopaedic surgery training in Rotterdam between 1987 and 1993. Since 1993 he works as an orthopaedic spine surgeon at the University Medical Centre Utrecht. He obtained his PhD (cum laude) in 1999 from the University of Utrecht. The work for his PhD thesis focused on the diagnostic and prognostic parameters in spinal trauma patients. He is the head of the neuro-orthopaedic spine unit since 2002. Cumhur �ner has actively participated in the foundation of the international Spine Trauma Study Group and is currently member of the steering committee of the Knowledge Forum Trauma of the AOSpine International. He has been involved in clinical spine research as well as the bone and intervertebral disc RM program in the UMC Utrecht. He was the president of the Dutch Spine Society between 2007-2011.