Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data

1992 ◽  
Vol 76 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Michael B. Bracken ◽  
Mary Jo Shepard ◽  
William F. Collins ◽  
Theodore R. Holford ◽  
David S. Baskin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Function ◽  
Controlled Trial ◽  
Acute Spinal Cord Injury ◽  
Sensory Function ◽  
Content Type ◽  
Cord Injury ◽  
Multicenter Randomized Controlled Trial

✓ The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.

Neurological and functional status 1 year after acute spinal cord injury: estimates of functional recovery in National Acute Spinal Cord Injury Study II from results modeled in National Acute Spinal Cord Injury Study III

2002 ◽  
Vol 96 (3) ◽  
pp. 259-266 ◽  
Author(s):  
Michael B. Bracken ◽  
Theodore R. Holford
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Function ◽  
Acute Spinal Cord Injury ◽  
Neurological Injury ◽  
High Dose ◽  
Content Type ◽  
Function Recovery ◽  
Cord Injury ◽  
Fine Print

Object. In the second National Acute Spinal Cord Injury Study (NASCIS II) investigators evaluated several standard neurological parameters but not functional activity. This has led to questions concerning the clinical importance of the increase in neurological recovery observed following administration of methylprednisolone (MP) within 8 hours of acute spinal cord injury (SCI). The safety of the therapy has also been questioned. Methods. Both neurological and functional recovery were assessed in NASCIS III, a trial that followed an almost identical protocol to NASCIS II. In the current analysis locally weighted scatterplot smoothing (LOESS) nonparametric regression is used to model the extent of recovery in the Functional Independence Measure (FIM) that is predicted by improvement in the NASCIS/American Spinal Cord Injury Association motor scores that were documented in NASCIS III 1 year after SCI, and the models are applied to the extent of motor recovery demonstrated in NASCIS II. The models predict improvement in FIM that would be expected from the motor function recovery observed in NASCIS II. Estimates are provided overall and for patients with complete and incomplete neurological loss at time of injury. The authors review recent evidence obtained from randomized studies documenting adverse effects that may result from high-dose MP therapy. The relationship between motor function and FIM is strongly nonlinear and dependent on initial level of injury and degree of injury severity. In the best statistical model, the expanded motor score could be used to explain 77.2% of the variability in the FIM. Based on the mean MP-related 3.6-unit improvement in the motor score for patients with complete injuries and 7.3 for those with incomplete injuries owed to MP in NASCIS II, 18.6% of patients would improve six or more FIM points and 9% nine or more points, respectively. In those with complete neurological injury, the mean motor improvement of 3.6 predicted that 63.9% of the patients would improve three or more FIM points and 12.1% six or more points to a maximum of eight points. Of those with incomplete neurological injury, a 7.3 mean improvement in motor function predicted that 27.4% would gain six or more FIM points and that 21% would gain nine or more points to a maximum of 15 points. Analysis of the current best evidence from SCI and other randomized surgical trials in which high-dose MP has been administered provides no grounds for concern about commonly studied adverse effects. Conclusions. The extent of MP therapy—related motor function recovery observed in NASCIS II predicted clinically important recovery in the FIM. Reasons to be cautious with regard to this prediction include the lack of robustness in statistical modeling, some loss of validity in the FIM, and considerable heterogeneity in the SCI population. Whatever functional activity is ascribed to high-dose MP therapy, it is does not appear to be associated with risk of adverse outcomes.

scholarly journals An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Huan-xia Li ◽  
Jing Cui ◽  
Jing-shi Fan ◽  
Jian-zhou Tong
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hyperbaric Oxygen ◽  
Clinical Efficacy ◽  
Acute Spinal Cord Injury ◽  
Sensory Function ◽  
Control Group ◽  
Thoracolumbar Fractures ◽  
Cord Injury ◽  
Experimental Group

Objective: To examine the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen therapy in treating thoracolumbar vertebral fracture-induced acute spinal cord injury (ASCI). Methods: From June 2015 to May 2018, 80 patients with thoracolumbar fractures and ASCI who were treated at Baoding First Central Hospital were selected. All patients underwent posterior laminectomy and screw fixation, and they were randomly divided into two groups using a random number table method. The control group received conventional postoperative treatment, while the experimental group was treated with riluzole combined with mannitol and hyperbaric oxygen on the basis of conventional treatment. The recovery of nerve function which included motor function and sensory function, and the changes of serum IL-6, CRP, BDNF, BFGF and other factors before treatment and four weeks after treatment of the two groups of patients were observed and evaluated. Results: After treatment, the motor function scores and sensory function scores of the two groups of patients were improved compared with those before treatment (p<0.05). Compared with the control group, the experimental group improved significantly, and the difference was statistically significant (p<0.05). The levels of IL-6, BDNF and NFGF in the experimental group were significantly lower than those in the control group (p<0.05). Conclusions: For patients with thoracolumbar fractures and ASCI undergoing laminar decompression and fixation, the comprehensive treatment plan of riluzole combined with mannitol and hyperbaric oxygen has certain advantages. Compared with the conventional therapy, it may significantly improve the movement and sensory functions of patients, relieve the inflammatory response of spinal cord, and promote recovery from the injury. doi: https://doi.org/10.12669/pjms.37.2.3418 How to cite this:Li H, Cui J, Fan J, Tong J. An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3418 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.

scholarly journals Role of methyleprednisolone succinate in the management of acute spinal cord injury

1970 ◽  
Vol 9 (3) ◽  
pp. 168-172
Author(s):  
NK Karn ◽  
BP Shrestha ◽  
GP Khanal ◽  
R Rijal ◽  
P Chaudhary ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Status ◽  
Acute Spinal Cord Injury ◽  
Cord Injury ◽  
And Gender ◽  
One Year

Objective: To see the role of methyleprednisolone succinate in the management of acute spinal cord injury. Methods: A randomized control trial was done including the patients with acute spinal cord injury. They were divided into age and gender matched two groups. Patients with presence of active infection, associated open fracture, those on long term steroid and those who did not give consent to participate in the trial were excluded. One group received methyleprednisolone succinate within 8 hours of injury and another group did not receive the drug. Both the groups were managed nonoperatively. The neurological status of the patients was assessed at presentation, once spinal shock was over, at 6th week and 6th month and after one year according to ASIA scoring. Frankel grading was also assessed in every follow up. Conclusion: Methylprednisolone succinct prevents secondary cord injury to a great extent and hence its administration within 8 hours of injury results in a better functional (motor and sensory) outcome. Keywords: acute spinal cord injury; methyleprednisolone succinate DOI: http://dx.doi.org/10.3126/hren.v9i3.5585   HR 2011; 9(3): 168-172

Neurological prognosis after traumatic quadriplegia

1979 ◽  
Vol 50 (5) ◽  
pp. 611-616 ◽  
Author(s):  
Frederick M. Maynard ◽  
Glenn G. Reynolds ◽  
Steven Fountain ◽  
Conal Wilmot ◽  
Richard Hamilton
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Head Injuries ◽  
Gunshot Wounds ◽  
Neurological Impairment ◽  
Treatment Protocols ◽  
Content Type ◽  
Cord Injury

✓ Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year follow-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete function at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cord injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.

scholarly journals Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study

1999 ◽  
Vol 6 (1) ◽  
pp. E4 ◽  
Author(s):  
Charles H. Tator ◽  
Michael Fehlings ◽  
Kevin Thorpe ◽  
Wayne Taylor
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Randomized Controlled Trial ◽  
Spinal Injury ◽  
Controlled Trial ◽  
Cauda Equina ◽  
Timing Of Surgery ◽  
Acute Spinal Cord Injury ◽  
Randomized Controlled ◽  
Cord Injury

A multicenter retrospective study was performed in 36 participating North American centers to examine the use and timing of surgery in the treatment of acute spinal cord injury (SCI). The study was conducted to obtain information required for the planning of a randomized controlled trial of early compared with late decompressive surgery. The records of all patients aged 16 to 75 years with acute SCI who were admitted to the 36 centers within 24 hours of injury over a 9-month period (August 1994 to April 1995) were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to these centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and an absence of spinal cord compression demonstrated on imaging studies. Thus, only approximately 50% of acute SCI patients would be eligible for inclusion in a study of acute decompressive procedures. Although 100% of patient underwent computerized tomography (CT) scaning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients with cervical injuries, of which only 42% demonstrated successful decompression by traction. Neurological deterioration occurred in 8.1% of patients after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours in 23.5% of patients; 25 to 48 hours in 15.8%; 48 to 96 hours in 19.0%; and 5 days or longer in 41.7% of patients. These data indicate that whereas surgery is commonly performed in patients with acute SCI, one-third of the cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to determine the optimum timing of surgical decompressive procedures in patients with SCI.

DREZ lesions for relief of pain related to spinal cord injury

1986 ◽  
Vol 65 (4) ◽  
pp. 465-479 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pain Relief ◽  
Intractable Pain ◽  
Content Type ◽  
Root Entry Zone ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Good Pain Relief

✓ Fifty-six patients with intractable pain following a spinal cord injury were treated with dorsal root entry zone (DREZ) lesions. After a follow-up period ranging from 6 months to 6 years, 50% of patients had good pain relief. Certain pain syndromes tended to respond better to DREZ lesions than did others. Patients with pain extending caudally from the level of the injury and patients with unilateral pain were most likely to obtain pain relief from the procedure; diffuse pain and predominant sacral pain did not respond as well.

Late neurological changes following traumatic spinal cord injury

1988 ◽  
Vol 69 (3) ◽  
pp. 399-402 ◽  
Author(s):  
Joseph M. Piepmeier ◽  
N. Ross Jenkins
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Neurological Status ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.

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