Keck’s Advanced Spinal Cord Injury Care at USC Spine Center

Traumatic spinal cord injury (SCI) is usually a devastating development for the individual and family. With current standard of care for SCI, patients may have a chance to recover some of their neurological function over the first six months to few years after injury.¹ The ultimate prognosis depends heavily on the severity of the injury and the timing of the treatment. Most patients will likely possess some persistent functional and sensory deficits.

Time is Spine¹
Early treatment, within the first few hours of SCI, is critical to implement any neuroprotective interventions for the patient. Doing so can profoundly affect the patient’s long-term prognosis. Current clinical practice guidelines state that patients with SCI should be managed in an intensive care unit with appropriate monitoring and transferred to a specialized center for spine care.^2,3

Keck’s Team Approach
The world-renowned USC Spine Center has been recognized as a Blue Distinction Center for its expertise in spine surgery by Blue Shield of California. From our extensive experience treating patients with SCI, we assess each patient and tailor our treatment and management to their specific needs.
Our multidisciplinary approach to treating patients with SCI includes a team of trauma surgeons, neurosurgeons and orthopaedic surgeons working together during the acute injury phase, followed by the collaboration with specialized radiologists, physiotherapists and occupational therapists. Patients can be easily transferred to be cared for by experts in SCI recovery at the Keck Hospital of USC Acute Rehabilitation Unit or Rancho Los Amigos National Rehabilitation Center in Downey, CA for ongoing care by faculty members of the Keck Medicine of USC. At both of these institutions, patients can learn to maximize their abilities after SCI.

A Leading Site for Clinical Trials
While standard of care can lead to modest improvements in outcomes, there is still a need for therapies that provide significant neurological recovery after SCI. The USC Spine Center is participating in three clinical trials to test novel adjuncts to standard of care for SCI.
In the SPRING trial, patients with acute cervical SCI who require decompression/stabilization surgery will be randomized to receive either VX-210, to inhibit Rho protein (which blocks neural regeneration after injury), or placebo. Patients who undergo surgery within 72 hours of injury are eligible to have VX-210 applied directly to the spinal cord during the procedure. Patients will be followed for at least six months to document their changes in motor scores and functional scores (NCT02669849). The USC Spine Center is the only study site in Southern California participating in the SPRING trial.
The INSPIRE Study is a Phase three, open-label study of the Neuro-Spinal Scaffold™ in patients with an American Spinal Injury Association Impairment Scale (AIS) A thoracic SCI (NCT02138110). The investigational item is a bioresorbable polymer scaffold, which is composed of two polymers that are designed to provide structural support and an attachment surface to promote cellular adhesion. During surgery to implant the scaffold, surgeons remove some of the necrotic soft tissues resulting from the injury using ultrasound guidance. Patients enrolled in this study will be followed for up to six months for functional, motor and sensory outcomes. The USC Spine Center is the only INSPIRE study site in the Los Angeles Area.
Finally, the USC Spine Center is participating in the SCISTAR trial of oligodendrocyte progenitor cells in patients with cervical SCI. The stem cells will be injected into the injury area and patients will be evaluated for up to one year for safety and efficacy outcomes (NCT02302157).
In addition to clinical trials, scientists at Keck Medicine of USC are conducting basic and translational research into topics related to SCI, such as the effect of micro-mRNA on recovery after SCI, inflammatory markers in cerebrospinal fluid in the acute injury phase and methods of evaluating patients who present with a possible SCI.

REFERENCES

1. Ahuja CS, Wilson JR, Nori S, et al. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017;3:17018.
2. Fehlings MG, Tetreault LA, Wilson JR, et al. A clinical practice guideline for the management of acute spinal cord injury: Introduction, rationale, and scope. Global Spine J. 2017;7:84S-94S.
3. Martin AR, Aleksanderek I, Fehlings MG. Diagnosis and acute management of spinal cord injury: Current best practices and emerging therapies. Curr Trauma Rep. 2015;1:169-181.