Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry

Abstract

In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR).We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression.Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1–T1) rather than thoracolumbar (T2–L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02)NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

Management of burst fractures in the thoracolumbar spine

“…The test of efficiency of this pharmaceutical and its effects are weak and could represent effects due to random factors. [25][26][27] 7. Conservative treatment 7.1.…”

Mitochondrial-Based Therapeutics for the Treatment of Spinal Cord Injury: Mitochondrial Biogenesis as a Potential Pharmacological Target

“…There are many potential side effects of high doses of MP, including an increased risk of gastrointestinal bleeding, deep vein thrombosis, pneumonia, septic shock, and delayed wound healing (Evaniew et al, 2015), which can offset the neuroprotective effects of MP and compromise functional outcome and even survival. In addition, treatment initiation past the 8-hour window can actually exacerbate injury and decrease recovery compared with no treatment (Bracken and Holford, 1993).…”

Clinical therapeutic guideline for neurorestoration in spinal cord injury (Chinese version 2016)

“…Hence, high-dose MP therapy has no longer been used routinely in acute SCI, but it is still an optional therapeutic method. [17][18][19] MP can still be used in incomplete cervical medullary lesions, and especially in patients with a cervical spondylitis myelopathy which requires a decompression, but caution should be paid on the following factors: (a) Time window (less than 8 hours): infusion speed should be controlled strictly in the application of high-dose MP with accurate measurement of body weight and dose. 20 MP should be given as a bolus dose of 30 mg/kg over 15 minutes, followed by a continuous 23-hour infusion of 5.4 mg/kg/hour.…”