title: Changing face of spine trauma care in North America.
abstract: METHODS
  An evidence-based review and summary of literature from multiple disciplines involved in spine trauma.
  
  
  OBJECTIVE
  To outline epidemiologic, clinical, and research issues influencing spine trauma in a longitudinal perspective. In addition, to provide guidance to clinicians and researchers to ensure that philosophies pertaining to the betterment of spine trauma care are understood and supported.
  
  
  BACKGROUND
  Epidemiologic data have provided insight into future demands the elderly patient with spine injury will place on the health care system. Regional trauma programs have emerged with further specialization resulting in regionalized spine trauma care. Evidence-based guidelines have streamlined imaging, and biomaterial advancements have facilitated the stabilization of the spinal column and decompression of the spinal cord. Promising experimental therapies promoting axonal regeneration and neuroprotective agents are beginning clinical trials, generating cautious optimism that effective therapies for spinal cord injuries will emerge. The unsustainable economics of increasing technology and patient expectations will make economic evaluation critical.
  
  
  METHODS
  Evidence-based review of current literature and expert opinion.
  
  
  CONCLUSIONS
  Multicenter spine trauma registries with patient-reported outcomes will allow many questions around spine trauma to be answered using the highest levels of evidence. This process in synergy with technical and biologic developments should ensure progress toward optimal care of the spine trauma patient. Future challenges will be to treat the breadth and magnitude of the discoveries within the fiscal restraints of the health care system and ensure its affordability for society.
authors: Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada. charles.fisher@vch.ca
authors: Charles G
authors: CG
authors: Fisher
authors: Vanessa K
authors: VK
authors: Noonan
authors: Marcel F
authors: MF
authors: Dvorak