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Effects of the Second National Acute Spinal Cord Injury Study of High-Dose Methylprednisolone Therapy on Acute Cervical Spinal Cord Injury–Results in Spinal Injuries Center

Tsutsumi, Satoshi, MD, PhD*; Ueta, Takayoshi, MD, PhD; Shiba, Keiichiro, MD, PhD; Yamamoto, Shunsaku, MD; Takagishi, Kenji, MD, PhD*

doi: 10.1097/01.brs.0000250273.28483.5c
Cervical Spine
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Study Design. Retrospective single-center study.

Objective. To evaluate the recovery of motor function and the early complications in patients with acute cervical spinal cord injury after receiving a high dose of methylprednisolone sodium succinate (MPSS) within 8 hours of injury.

Summary of Background Data. High-dose MPSS therapy has been demonstrated to improve the neurologic recovery in patients with acute spinal cord injury. However, it remains a controversial treatment.

Methods. Seventy patients were included in this study: 37 in the MPSS group who were treated with MPSS within 8 hours of their injury according to the Second National Acute Spinal Cord Injury Study protocol, and 33 in non-MPSS group who were not administered with MPSS. Improvements in the American Spinal Injury Association motor score were compared between the MPSS group and the non-MPSS group. In patients with complete motor loss at admission and follow-up periods, improvements of myotomal levels between the MPSS (n = 15) and non-MPSS groups (n = 21) were compared. Early complications within 6 weeks of high-dose MPSS therapy were compared with those of no MPSS therapy.

Results. Among the patients with incomplete paralysis at admission, the American Spinal Injury Association motor scores in the MPSS group were improved more significantly than those in the non-MPSS group at 6 weeks and 6 months after injury. Meanwhile, among the patients with complete paralysis at admission, the patients in the MPSS group did not show significantly more change in motor score than those in the non-MPSS group. Improvement in myotomal level had no significant difference between the MPSS and non-MPSS groups. The MPSS group had 10 patients with early complications, while the non-MPSS group had 14. The differences between the 2 groups showed no statistical significance.

Conclusions. MPSS should be administered to patients with incomplete cervical spinal cord injury according to the Second National Acute Spinal Cord Injury Study protocol.

In this study, patients who were treated with methylprednisolone sodium succinate (MPSS) within 8 hours of their injury according to the Second National Acute Spinal Cord Injury Study protocol and patients who were not administered with MPSS were compared with regard to improvement in the American Spinal Injury Association motor score and myotomal levels. Early complications within 6 weeks of high-dose MPSS therapy were compared with those of no MPSS therapy in patients with acute cervical spinal cord injury. The present study showed that high-dose MPSS therapy according to the Second National Acute Spinal Cord Injury Study was effective for neurologic improvement in patients with incomplete cervical spinal cord injury and no correlation with early complications in acute cervical spinal cord injury.

From the Department of Orthopaedic Surgery, *Gunma University Graduate School of Medicine, Gunma; and † Spinal Injuries Center, Fukuoka, Japan.

Acknowledgment date: January 6, 2005. First revision date: October 3, 2005. Second revision date: April 16, 2006. Acceptance date: April 17, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Satoshi Tsutsumi, MD, PhD, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan; E-mail: stutumi@med.gunma-u.ac.jp

© 2006 Lippincott Williams & Wilkins, Inc.