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

JOURNAL OF NEUROTRAUMA, 2015 · DOI: 10.1089/neu.2015.3963 · Published: November 1, 2015

Spinal Cord Injury Pharmacology Neurology

Simple Explanation

This study investigates whether methylprednisolone, a steroid, improves motor recovery in patients with acute traumatic spinal cord injuries (TSCIs). The research considers the severity and location of the injury, factors often overlooked in previous studies. The study used a propensity score-matched cohort design, comparing patients who received methylprednisolone to those who did not. This method helps to account for differences in patient characteristics that could influence the results. The findings suggest that methylprednisolone does not improve motor score recovery in patients with acute TSCIs. Furthermore, the study found a higher rate of total complications in the group that received methylprednisolone.

Study Duration

May 2004 to March 2014

Participants

2009 patients with acute TSCIs

Evidence Level

Not specified

Key Findings

1
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.
2
There was a signiﬁcantly higher rate of total complications in the NASCIS-II methylprednisolone group.
3
Cervical rather than thoracic injury levels ( p < 0.01) and reduced baseline injury severity (ASIA Impairment Scale A, B, C, or D; p < 0.01) were each signiﬁcantly associated with greater TMS recovery.

Research Summary

This study aimed to determine if methylprednisolone improves motor recovery in acute TSCI patients, considering neurological level and injury severity. The results indicated that methylprednisolone did not improve motor score recovery and was associated with a higher rate of complications. The ﬁndings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

Practical Implications

Clinical Guidelines

The findings support recommendations against the routine use of methylprednisolone in acute TSCI, suggesting a need to re-evaluate treatment protocols.

Future Research

Future studies should consider the neurological level and severity of injury as critical prognostic factors when evaluating interventions for TSCI.

Patient Counseling

Clinicians should carefully weigh the potential risks and benefits of methylprednisolone treatment in light of the lack of evidence supporting its effectiveness and the potential for increased complications.

Study Limitations

1
The timing of ISNCSCI examinations was not standardized, and differences in timing could have introduced bias in the results.
2
We identiﬁed only 46 patients who received the NASCIS-II regimen of methylprednisolone within 8 h of their injuries since 2005. This sample size is small and may limit conﬁdence in our results, particularly the rates of complications.
3
Propensity score matching cannot adjust for unknown confounders.

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