The AO Spine Knowledge Forum for Spinal Cord Injury (KF SCI) is an international group of dedicated spine surgeons who seek to define new treatment approaches and address critical knowledge gaps to enhance outcomes for both traumatic and non-traumatic spinal cord injury patients. It is one of five Knowledge Forums within AO Spine, a global clinical division of the AO Foundation established in 2003.

SCOLI's Involvement

• Dr. Nitin Agarwal, SCOLI Co-Director, is an active member of the AO Spine Knowledge Forum for SCI, contributing to international guideline development and multi-center research.
• Dr. Agarwal has co-authored publications on behalf of the KF SCI, including the 2025 clinical practice recommendations for surgical management of acute traumatic spinal cord injury.
• SCOLI contributes to multi-center collaborative research and clinical guideline development alongside international spine surgery experts.

Mission & Scope of Work

• Developing evidence-based clinical practice guidelines for SCI management
• Conducting multi-center prospective studies across international centers
• Creating consensus recommendations through modified Delphi processes
• Standardizing care protocols and outcome measures across centers

Major Initiatives

Clinical Practice Guidelines (2017 & 2024)

Comprehensive guidelines for acute spinal cord injury management covering surgical decompression timing, hemodynamic management, and intraoperative SCI. Also includes guidelines for Degenerative Cervical Myelopathy (DCM).

Strong recommendation: surgical decompression within 24 hours when medically feasible.

I-SCRIBBLE Study

International Spinal Cord Injury Blood Biomarker Longitudinal Evaluation

A multi-center prospective observational study evaluating serum NF-L and GFAP levels as biomarkers for predicting neurologic outcomes in spinal cord injury patients.

ClinicalTrials.gov: NCT06839300

RECODE-DCM Initiative

A multidisciplinary effort to define research priorities for Degenerative Cervical Myelopathy, including development of a comprehensive research toolkit and standardized diagnostic criteria.

Classification Systems

Development of practical classification systems for cervical spinal cord injury through international Delphi consensus, enabling standardized communication and treatment decision-making across centers.

RISCIS Trial

A randomized controlled trial evaluating Riluzole as a neuroprotective agent in acute spinal cord injury, investigating its potential to improve neurological recovery.

Research Methodologies

• Systematic reviews and meta-analyses
• Modified Delphi consensus studies
• International surveys of spine surgeons
• Multi-center prospective cohort studies
• Development of outcome measures and classification systems
• Randomized controlled trials

International Collaboration Structure

The KF SCI operates through an international network of clinical experts from all AO Spine regions, including North America, Latin America, Europe, Asia Pacific, and the Middle East. The forum partners with organizations such as the Praxis Spinal Cord Institute to advance SCI research and care.

Guideline development follows the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology for transparent and rigorous evidence appraisal. Guideline Development Groups (GDGs) are multidisciplinary, including surgeons, clinicians, and patients with lived experience to ensure comprehensive and patient-centered recommendations.