McMaster University

McMaster University

Methylprednisolone for the treatment of patients with acute spinal cord injuries

We are pleased to share with you a recent publication in the Journal of Neurotrauma. This publication is entitled "Methylprednisolone for the treatment of patients with acute spinal cord injuries: A propensity score-matched cohort study from a Canadian multicenter spinal cord injury registry."

Find the abstract below and click here to access the full-version of the article.

Evaniew N, Noonan V, Fallah N, Kwon BK, Rivers CS, Ahn H, Bailey C, Christie S, Fourney DR, Hurlbert RJ, Linassi G, Fehlings M, Dvorak MF. Methylprednisolone for the treatment of patients with acute spinal cord injuries: A propensity score-matched cohort study from a Canadian multicenter spinal cord injury registry. J Neurotrauma. 2015 Jun 12. [Epub ahead of print]

Abstract

OBJECTIVE: 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).

METHODS: We identified RHSCIR participants that received methylprednisolone according to the 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.

RESULTS: 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 (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)

CONCLUSIONS: 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 anatomic 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.

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