Early Complications of High-Dose Methylprednisolone Sodium Succinate Treatment in the Follow-Up of Acute Cervical Spinal Cord Injury

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”; (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.

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Early complications of high-dose methylprednisolone in acute spinal cord injury patients

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)79077-4 ◽

2009 ◽

Vol 2009 ◽

pp. 242-243

Author(s):

J.J. Provencio

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Acute Spinal Cord Injury ◽

High Dose ◽

Early Complications ◽

High Dose Methylprednisolone ◽

Cord Injury

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Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database

Emergency Medicine Journal ◽

10.1136/emermed-2012-202058 ◽

2013 ◽

Vol 31 (3) ◽

pp. 201-206 ◽

Cited By ~ 54

Author(s):

Hirotaka Chikuda ◽

Hideo Yasunaga ◽

Katsushi Takeshita ◽

Hiromasa Horiguchi ◽

Hiroshi Kawaguchi ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Administrative Database ◽

High Dose ◽

Mortality And Morbidity ◽

High Dose Methylprednisolone ◽

Cord Injury ◽

Methylprednisolone Treatment

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Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: A Systematic Review

Global Spine Journal ◽

10.1177/2192568217706366 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 116S-137S ◽

Cited By ~ 22

Author(s):

Michael G. Fehlings ◽

Jefferson R. Wilson ◽

James S. Harrop ◽

Brian K. Kwon ◽

Lindsay A. Tetreault ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Systematic Reviews ◽

Sodium Succinate ◽

Research Articles ◽

High Dose ◽

Methylprednisolone Sodium Succinate ◽

Cord Injury

Study Design: Systematic review and meta-analysis. Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI). Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated and evaluated using the Assessment of Multiple Systematic Reviews scoring system. Results: The search yielded 723 citations, 13 of which satisfied inclusion criteria. Among these, 6 were primary research articles and 7 were previous systematic reviews. Based on the included research articles, there was moderate evidence that the 24-hour NASCIS II (National Acute Spinal Cord Injury Studies) MPSS regimen has no impact on long-term neurological recovery when all postinjury time points are considered. However, there is also moderate evidence that subjects receiving the same MPSS regimen within 8 hours of injury achieve an additional 3.2 points (95% confidence interval = 0.10 to 6.33; P = .04) of motor recovery compared with patients receiving placebo or no treatment. Conclusion: Although safe to administer, a 24-hour NASCIS II MPSS regimen, when all postinjury time points are considered, has no impact on indices of long-term neurological recovery. When commenced within 8 hours of injury, however, a high-dose 24-hour regimen of MPSS confers a small positive benefit on long-term motor recovery and should be considered a treatment option for patients with SCI.

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Intermittent injection of Methylprednisolone Sodium Succinate in the treatment of Cervical Spinal Cord injury complicated with incomplete paraplegia

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.211 ◽

2019 ◽

Vol 35 (1) ◽

Cited By ~ 2

Author(s):

Wei Wang ◽

Baoshu Zuo ◽

Haixia Liu ◽

Limin Cui

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Adverse Reactions ◽

Cervical Spinal Cord ◽

Sodium Succinate ◽

Cervical Spinal Cord Injury ◽

Control Group ◽

Observation Group ◽

Methylprednisolone Sodium Succinate ◽

Cord Injury

Objective: To evaluate the clinical efficacy and safety of intermittent injection of methylprednisolone sodium succinate in the treatment of cervical spinal cord injury complicated with incomplete paraplegia. Methods: Seventy-eight patients with cervical spinal cord injury complicated with incomplete paraplegia who were admitted between August 2016 and December 2017 were enrolled and grouped into an observation group and a control group using random number table, 39 in each group. Patients in the control group were given vertebral body decompression and bone grafting and internal fixation according to the severity of spinal cord compression, while patients in the observation group were treated by methylprednisolone sodium succinate in addition to the same treatment as the control group. The clinical efficacy and medicine associated adverse reactions were compared between the two groups. Results: The cure rate of the observation group was significantly higher than that of the control group (46.2% (18/39) vs. 20.5% (8/39)). After the treatment, the Japanese Orthopaedic Association (JOA) score and American Spinal Cord Injury Association (ASIA) score of the two groups after treatment were significantly higher compared to before treatment, and the scores of the observation group were much higher than those of the control group (P<0.05). The incidence of adverse reactions of the observation and control groups was 15.4% and 17.9% respectively, and the difference was not statistically significant (P>0.05). Conclusion: Intermittent injection of methylprednisolone sodium succinate has definite efficacy in treating cervical spinal cord injury complicated with incomplete paraplegia, with a low incidence of adverse reactions; hence it is worth promotion. How to cite this:Wang W, Zuo B, Liu H, Cui L. Intermittent injection of Methylprednisolone Sodium Succinate in the treatment of Cervical Spinal Cord injury complicated with incomplete paraplegia. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.211 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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