title: Clinical evaluation of a neuroprotective drug in patients with cervical spondylotic myelopathy undergoing surgical treatment: design and rationale for the CSM-Protect trial.
abstract: METHODS
  Descriptive article and narrative review.
  
  
  OBJECTIVE
  To explain the rationale and design of the cervical spondylotic myelopathy (CSM)-Protect clinical trial that aims to elucidate the efficacy and safety of riluzole in the context of CSM.
  
  
  BACKGROUND
  CSM is the most common cause of spinal cord-related dysfunction internationally. Although surgery is effective in preventing the progression of impairment, and in some cases improving functional outcomes, many patients continue to exhibit significant disability in the postoperative setting. Evidence from preclinical studies suggests that glutamate-related excitotoxicity may contribute to the pathology of CSM and that administration of the sodium and glutamate-blocking medication riluzole, when combined with spinal cord decompression, may mitigate this effect and improve neurobehavioral outcomes. Although riluzole is FDA approved and has been shown to be safe and effective in the context of amyotrophic lateral sclerosis, its efficacy and safety in the context of CSM remain unknown.
  
  
  METHODS
  Descriptive article with narrative review of the literature.
  
  
  RESULTS
  In addition to providing pertinent preclinical background on the topic, this descriptive article and narrative review discusses the design and current status of an ongoing phase III randomized controlled trial evaluating the efficacy and safety of riluzole, combined with surgical decompression, in the treatment of CSM.
  
  
  CONCLUSIONS
  On the basis of current projections, we estimate that the interim analysis for this study will take place in the spring of 2014, at which time an adaptive sample size adjustment may take place.
authors: *Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada †Department of Neurosurgery, University of Kansas, Kansas City, KS; and ‡Department of Health Services, University of Washington, Seattle, WA.
authors: Michael G
authors: MG
authors: Fehlings
authors: Jefferson R
authors: JR
authors: Wilson
authors: Spyridon K
authors: SK
authors: Karadimas
authors: Paul M
authors: PM
authors: Arnold
authors: Branko
authors: B
authors: Kopjar
mesh_terms: D002574:Cervical Vertebrae / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D019782:Riluzole / Q000627:therapeutic use*; D013118:Spinal Cord Diseases / Q000188:drug therapy* / Q000601:surgery; D055009:Spondylosis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D018696:Neuroprotective Agents; D019782:Riluzole