Acta Chir Orthop Traumatol Cech. 2011; 78(4):305-313 | DOI: 10.55095/achot2011/047

Current Role of Methylprednisolone in the Treatment of Acute Spinal Cord InjuryCurrent concepts review

R. LUKÁ©1,*, I. ZÝKOVÁ2, P. BARSA3, J. ©RÁM1
1 Traumacentrum se spinální jednotkou KNL, a. s.
2 ARO KNL, a. s.
3 Neurochirurgické oddělení KNL, a. s.

High doses of methylprednisolone (MPSS) came into use as part of a therapeutic protocol for acute spinal cord injuries following the published results from the NASCIS II study in 1992; they soon became a standard of care around the world. However, the results of this study have been critically reviewed and questioned by many authors since the beginning. The major argument is based on the fact that its effectiveness in reducing post-injury neurological damage has not been conclusively proved; in addition, there has been increasing evidence of serious side effects of steroids administered at high doses.
In the Czech Republic, as part of pre-hospital care, MPSS according to the NASCIS II (or NASCIS III) protocol is used in all regional centres of emergency medical service. In the Czech spinal surgery centres involved in treating acute spinal cord injuries, there are 19 of them, attitudes towards the use of MPSS vary. In 16% of the centres a certainty of its beneficial effect is still maintained, faith in its effect together with fear of a "non-lege artis" procedure is the reason for MSPP use in 21%, and the fear of sanctions only leads to its use in 63% of the centres. There is no standard practice in application of the NASCIS II and NASCIS III protocols and no standard exclusion criteria exist. The two protocols are used equally, and one institution has its own modification. The recommended MPSS dose is administered with no exception in 63% of the centres; dose adjustment is employed according to the form of spinal cord lesion in 11%, the level of spinal cord injury in 5%, associated diseases in 16% and patient age in 11% of the spinal surgery centres. After the results of studies on MPSS administration in acute spinal cord injury have been analysed, many medical societies have changed their recommendations. In view of later relevant publications it is no longer possible to regard MPSS administration as a standard of cure for acute spinal cord injury. Current evidence suggests that MPSS administration in a 24-hour regimen after an initial dose given within 8 hours of injury is the therapeutic procedure that needs individual consideration in each patient according to their state of health and potential complications. MPSS administration at an interval longer than 8 hours after injury and for more than 24 hours is not justified, nor is it justified to use a high MPSS dose at the place of injury by an emergency ambulance crew.

Keywords: corticosteroids, methylprednisolone, spinal cord trauma, neurological damage

Published: August 1, 2011  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
LUKÁ© R, ZÝKOVÁ I, BARSA P, ©RÁM J. Current Role of Methylprednisolone in the Treatment of Acute Spinal Cord Injury. Acta Chir Orthop Traumatol Cech. 2011;78(4):305-313. doi: 10.55095/achot2011/047. PubMed PMID: 21888840.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. BAPTISTE, D. C., FEHLINGS, M. G.: Pharmacological approaches to repair the injured spinal cord. J. Neurotrauma, 23(3-4): 318-34, 2006. Go to original source... Go to PubMed...
    2. BERNHARD, M., GRIES, A., KREMER, P., BOTTIGER, B. W.: Spinal cord injury (SCI) - prehospital management. Resuscitation, 66(2): 127-39, 2005. Go to original source... Go to PubMed...
    3. BRACKEN, M. B.: Steroids for acute spinal cord injury. Cochrane Database Syst. Rev., 3: CD001046, 2002. Go to original source...
    4. BRACKEN, M. B., SHEPARD, M. J., COLLINS, W. F., HOLFORD, T. R., ZOUNY, W., BASKIN, D. S., EISENBERG, H. M., FLAMM, E., LEO-SUMMERS, L., MAROON. J.: A randomised, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N. Engl. J. Med., 17; 322(20): 1405-11, 1990. Go to original source... Go to PubMed...
    5. BRACKEN, M. B., COLLINS, W. F., FREEMAN, D. F., SHEPPARD, M. J., WAGNER, F. W., SILTEN, R. M., HELLENBRAND, K. G., RANSOHOFF, J., HUNT, W. E., PEROT, P. L. Jr.: Efficacy of methylprednisolone in acute spinal cord injury. JAMA, 6, 251(1): 45-52, 1984. Go to original source...
    6. BRACKEN, M. B., SHEPARD, M. J., HOLFORD, T. R., LEO, L. S., ALDRICH, E. F., FAZL, M., FEHLINGS, M., HERR, D. L., HITCHON, P. W., MARSHALL, L. F., NOCKELS, R. P., PASCALE, V., PEROT, P. L. Jr, PIEPMEIER, J., SONNTAG, V. K., WAGNER, F., WILBERGER, J. E., WINN, H. R., YOUNG, W.: Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA, 277(20): 1597-604, 1997. Go to original source...
    7. COLEMAN, W. P., BENZEL, D., CAHILL, D. W., DUCKER, T., GEISLER, F., GREEN, B., GROPPER, M. R., GOFFIN, J., MADSEN, P. W. 3rd, MAIMAN, D. J., ONDRA, S. L., ROSNER, M., SASSO, R. C., TROST, G. R., ZEIDMAN, S.: A critical appraisal of the reporting of NASCIS II and III studies of methylprednisolone in acute spinal cord injury. J. Spinal Disord., 13(3): 185-99, 2000. Go to original source... Go to PubMed...
    8. ECK, J. C., NACHTIGALL, D., HUMPHREYS, S. C., HODGES, S. D.: Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine, 20, 31(9): E250-3, 2006. Go to original source... Go to PubMed...
    9. FRAMPTON, A. E., EYNON, C. A.: High dose methylprednisolone in the immediate management of acute, blunt spinal cord injury: what is the current practice in emergency departments, spinal units, and neurosurgical units in the UK? Emerg. Med. J., 23(7): 550-3, 2006. Go to original source... Go to PubMed...
    10. GEORGE, E. R., SCHOLTEN, D. J., BUECHLER, C. M., JORDAN-TIBBS, J., MATTICE, C., ALBRECHT, R. M.: Failure of methylprednisolone to improve the outcome of spinal cord injurie. Am. Surg. 61(8): 659-63, 1995. Go to PubMed...
    11. GERHART, K. A., JOHNSON, R. L., MENCONI, J., HOFFMAN, R. E., LAMMERTSE, D. P.: Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured persons. Paraplegia, 33(6): 316-21, 1995. Go to original source... Go to PubMed...
    12. GERNDT, S. J., RODRIGUEZ, J. L., PAWLIK, J. W., TAHERI, P. A., WAHL, W. L., MICHEALS, A. J., PAPADOPOULOS, S. M.: Consequences of high- dose steroid therapy for acute spinal cord injury. J. Trauma, 42(2): 279-84, 1997. Go to original source... Go to PubMed...
    13. GUPTA, R., BATHEN, M. E., SMITH, J. S., LEVI, A. D., BHATIA, N. N., STEWARD, O.: Advances in the management of spinal cord injury. J. Am. Acad. Orthop. Surg., 18(4):210-22, 2010. Go to original source... Go to PubMed...
    14. HASSE, W., WEIDTMANN, A., VOELTZ, P.: Lactic acidosis: a complication of spinal cord injury in multiple trauma. Unfallchirurg., 103(6): 495-8, 2000. Go to original source... Go to PubMed...
    15. HURLBERT, R. J.: Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J. Neurosurg., 93(1 Suppl): 1-7, 2000. Go to original source... Go to PubMed...
    16. HURLBERT, R. J.: The role of steroids in acute spinal cord injury: an evidence -based analysis. Spine, 26 (24 Suppl): 39-46, 2001. Go to original source... Go to PubMed...
    17. HURLBERT, R. J.: Strategies of medical intervention in the management of acute spinal injury. Spine, 31 (11 Suppl): 16-21, 2006. Go to original source... Go to PubMed...
    18. HURLBERT, R. J.: Why do you prescribe methylprednisolone for acute spinal cord injury? A Canadian perspective and a position statement. Can. J. Neurol. Sci., 29(3): 236-9, 2002. Go to original source... Go to PubMed...
    19. ITO, Y., SUGIMOTO, Y., TOMIOKA, M., KAI, N., TANAKA, M.: 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. Spine (Phila Pa 1976), 34(20): 2121-4, 2009. Go to original source... Go to PubMed...
    20. LEARY, W. E.: Treatment Is Said to Reduce Disability From Spinal Injury. The New York Times, March 31, 1990
    21. LEE, H. C., CHO, D. Y., LEE, W. Y., CHUANG, H. C.: Pitfalls in treatment of acute cervical spinal cord injury using high-dose methylprednisolone: a retrospect audit of 111 patients. Surg. Neurol., 68 Suppl 1: 37-41; 2007. Go to original source... Go to PubMed...
    22. MATSUMOTO, T., TAMAKI, T., KAWAKAMI, M., YOSHIDA, M., ANDO, M., YAMADA, H.: Early complications of high-dose methylprednisolone sodium succinate treatment in the follow up of acute cervical spinal cord injury. Spine (Phila Pa 1976), 26(4): 426-30, 2001. Go to original source... Go to PubMed...
    23. McCUTCHEON, E. P., SELASSIE, A. W., GU, J. K., PICKELSIMER, E. E.: Acute traumatic spinal cord injury, 1993-2000. A population based assessment of methylprednisolon administration and hospitalisation. J. Trauma, 56(5): 1076-83, 2004.
    24. NICHOLAS, J. S., SELASSIE, A. W., LINEBERRY, L. A., PICKELSIMER, E. E., HAINES, S. J.: Use and determinants of the methylprednisolone protocol for traumatic spinal cord injury in South Carolina acute care hospitals. J. Trauma, 66(5): 1446-50, 2009. Go to original source... Go to PubMed...
    25. OTANI, K., ABE, H., KADOYA, S., NAGAKAWA, H., IKATA, T., TOMINAGU, S.: Beneficial effect of methylprednisolone sodium succinate in the treatment of acute spinal cord injury. Sekitsui Sekizui J.: 633-47, 1994.
    26. PETIJEAN, M. E., POINTILLART, V., DIXMERIAS, F., WIART, L., SZTARK, F., LASSIE, P., THICOÏPÉ, M., DABADIE, P.: Medical treatment of spinal cord injury in the acute stage. Ann. Fr. Anesth. Reanim., 17(2): 114-22, 1998. Go to original source... Go to PubMed...
    27. POLLARD, M. E., APPLE, D. F.: Factors associated with improved outcomes in patients with incomplete tetraplegia. Spine, 28(1): 33-9, 2003. Go to original source... Go to PubMed...
    28. POYNTON, A. R., O FARRELL, D. A., SHANNON, F., MURRAY, P., MCMANUS, F., WALSH, M. G.: An evaluation of the factors affecting neurological recovery following spinal cord injury. Injury, 28(8): 545-8, 1997. Go to original source... Go to PubMed...
    29. PRENDERGAST, M. R., SAXE, J. M., LEDGERWOOD, A. M., LUCAS, C. E., LUCAS, W. F.: Massive steroids do not reduce the zone of injury after penetrating spinal cord injury. J. Trauma, 37(4): 576-9, 1994. Go to original source... Go to PubMed...
    30. QIAN, T., GUO, X., LEVI, A. D., VANNI, S., SHEBERT, R. T., SIPSKI, M. L.: High-dose methylprednisolone may cause myopathy in acute spinal cord injury patiens. Spinal Cord, 43(4): 199-203, 2005. Go to original source... Go to PubMed...
    31. SHORT, D. J., EL MASRY, W. S., JONES, P. W.: High dose methylprednisolone in the management of acute spinal cord injury - a systematic review from a clinical perspective. Spinal Cord, 38(5): 273-86, 2000. Go to original source... Go to PubMed...
    32. SPENSER, M. T., BAZARIAN, J. J.: Are corticosteroids effective in traumatic spinal cord injury? Ann. Emerg. Med., 41(3): 410-3, 2003. Go to original source... Go to PubMed...
    33. ©RÁMEK, J., ©TULÍK, J., ©EBESTA, P., VYSKOČIL, T., KRYL, J., NESNÍDAL, P., BARNA M.: Hyperextension trauma in patients with cervical spondylosis. Acta Chir. orthop. Traum. čech., 76(2): 128-32, 2009. Go to original source...
    34. ©TULÍK J, KLÉZL Z, ©EBESTA P, KRYL J, VYSKOČIL T.: Occipitocervical fixation: long-term follow-up in fifty-seven patiens. Acta Chir. orthop. Traum. čech., 76(6): 479-86, 2009 Go to original source...
    35. TATOR, C.: Review of treatment trials in human spinal cord injury: issues, difficulties and recommendations. Neurosurgery, 59(5): 957-82, 2006. Go to original source... Go to PubMed...
    36. TSUTSUMI, S., UETA, T., SHIBA, K., YAMAMOTO, S., TAKAGISHI, K.: 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. Spine, 31(26): 2992-6, 2006. Go to original source... Go to PubMed...

    Return to the content