Does High Dose Methylprednisolone Sodium Succinate Really Improve Neurological Status in Patient With Acute Cervical Cord Injury?

A Prospective Study About Neurological Recovery and Early Complications

Abstract

Study Design. 

Consecutive cohort study.

Objective. 

To reconsider effects of the Second National Acute Spinal Cord Injury Study.

Summary of Background Data. 

High dose methylprednisolone sodium succinate (MPSS) for the patients with acute spinal cord injury has been considered standard treatment in the several countries. However, many authors have criticized the effect of MPSS because of lack of evidence about neurologic improvement and the high incidence of complications.

Methods. 

During 2-year, all patients with cervical cord injury were treated with MPSS within 8 hours of their injuries based on the Second National Acute Spinal Cord Injury Study protocol (MPSS group). During the next 2-year, all patients were treated without MPSS (non-MPSS group). There were 38 patients in the MPSS group and 41 in the non-MPSS. Early spinal decompression and stabilization was performed as soon after injury in both the groups.

Results. 

According to The American Spinal Injury Association (ASIA) motor score, there was an average improvement by 3 months postinjury of 12.4 points in the MPSS group and 13.8 points in the non-MPSS group. In patients with complete motor loss, average ASIA motor score improved 9.0 points in the MPSS group and 12.6 points in the non-MPSS group. For patients with incomplete motor loss, average ASIA motor score improvement was 14.1 and 15.5 points in the MPSS and non-MPSS groups, respectively.

In the MPSS group, 19 patients developed pneumonia, 13 developed urinary tract infections, and 5 developed wound infections. Incidence of pneumonia was significantly increased with the use of MPSS medication.

Conclusion. 

We found no evidence supporting the opinion that high-dose MPSS administration facilitates neurologic improvement in patients with spinal cord injury. We believe MPSS should be used under limited circumstances because of the high incidence of pulmonary complication.

In Brief

In this consecutive cohort study, we prospectively treated patients with cervical cord injury using 2 protocols (The Second National Acute Spinal Cord Injury Study protocol using MPSS and a protocol without MPSS). Patients' neurologic recovery and complications were evaluated. We found no evidence supporting the opinion that high-dose MPSS administration facilitates neurologic improvement in patients with spinal cord injury.