PM&R
Volume 1, Issue 7 , Pages 669-673 , July 2009

Methylprednisolone After Traumatic Spinal Cord Injury: Yes or No?

  • John C. Liu, MD (Guest Discussant)

      Affiliations

    • Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL†
    • ,
  • Alpesh Patel, MD (Guest Discussant)

      Affiliations

    • Department of Orthopaedic Surgery and Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT‡
    • ,
  • Alexander R. Vaccaro, MD, PhD (Guest Discussant)

      Affiliations

    • Departments of Orthopaedics and Neurosurgery, Delaware Valley Spinal Cord Injury Center, Philadelphia, PA§
    • ,
  • Daniel P. Lammertse, MD (Guest Discussant)

      Affiliations

    • Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Craig Hospital, Denver, CO
    • ,
  • David Chen, MD (Senior Editor)

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, 345 E. Superior St, Rm 1146, Chicago, IL 60611∥
    • Corresponding Author InformationAddress correspondence to: D.C.

References 

    John C. Liu, MD, Responds
  1. Sekhor LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine. 2001;26(Suppl):S2–S12
  2. Amar PA, Levy ML. Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal cord injury. Neurosurgery. 1999;44:1027–1040
  3. Fehlings MG, Perrin RG. The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury. 2005;36(Suppl 2):B13–B26
  4. Coleman WP, Benzel D, Cahill DW, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord. 2002;13:185–199
  5. Tator CH. Biology of neurological recovery and functional restoration after spinal cord injury. Neurosurgery. 1998;42:696–708
  6. Bracken MB, Sheppard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of spinal-cord injury (Results of the Second National Acute Spinal Cord Injury Study). N Engl J Med. 1990;322:1405–1411
  7. Bracken MB, Sheppard MJ, Holford TR, et al. 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. 1997;277:1597–1604
  8. Poynton AR, O'Farrell DA, Shannon F, et al. An evaluation of the factors affecting neurological recovery following spinal cord injury. Injury. 1997;28:545–548
  9. Burns AS, Ditunno JF. Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management. Spine. 2001;26(Suppl):S137–S145
  10. Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomized placebo-controlled trial. Lancet. 2004;364:1321–1328
    Alpesh Patel, MD, and Alexander R. Vaccaro, MD, Respond
  1. Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251:45–52
  2. Bracken MB, Shepard MJ, Hellenbrand KG, et al. Methylprednisolone and neurological function 1 year after spinal cord injury (Results of the National Acute Spinal Cord Injury Study). J Neurosurg. 1985;63:704–713
  3. Bracken MB, Shepard MJ, Collins WF, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data (Results of the Second National Acute Spinal Cord Injury Study). J Neurosurg. 1992;76:23–31
  4. Bracken MB, Shepard MJ, Holford TR, et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up (Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial). J Neurosurg. 1998;89:699–706
  5. Bracken MB, Sheppard MJ, Collins WF, et al. A randomized, 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. 1990;322:1405–1411
  6. Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg. 2000;93(1 Suppl):1–7
  7. Young W, Bracken MB. The Second National Acute Spinal Cord Injury Study. J Neurotrauma. 1992;9(Suppl 1):S397–S405
  8. Bracken MB, Sheppard MJ, Holford TR, et al. 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. National Acute Spinal Cord Injury Study). JAMA. 1997;277:1597–1604
  9. Hadley MN, Walters BC, Grabb PA, et al. Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg. 2002;49:407–498
  10. Hurlbert RJ, Moulton R. Why do you prescribe methylprednisolone for acute spinal cord injury? (A Canadian perspective and a position statement). Can J Neurol Sci. 2002;29:236–239
  11. Hurlbert RJ, Hamilton MG. Methylprednisolone for acute spinal cord injury: 5-year practice reversal. Can J Neurol Sci. 2008;35:41–45
    Daniel P. Lammertse, MD, Guest Commentary
  1. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury: results of the second National Acute Spinal Cord Injury Trial. N Engl J Med. 1990;322:1405–1411
  2. Leary WE. Treatment is said to reduce disability from spinal injury. New York Times; March 31, 1990;
  3. Gerhart KA, Johnson RL, Menconi J, Hoffman RE, Lammertse DP. Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured persons. Paraplegia. 1995;33:316–321
  4. Nesathurai S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma. 1998;45:1088–1093
  5. Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg. 2000;93(1 Suppl):1–7
  6. Short DJ, El Masry WS, Jones PW. High dose methylprednisolone in the management of acute spinal cord injury—a systematic review from a clinical perspective. Spinal Cord. 2000;38:273–286
  7. Coleman WP, Benzel E, Cahill D, et al. A critical reappraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord. 2000;13:185–199
  8. Sayer FT, Kronvall E, Nilsson OG. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature. Spine J. 2006;6:335–343
  9. Hadley MN. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery. 2002;50(Suppl):S63–S72
  10. Bracken MB. Comments. Neurosurgery. 2002;50(Suppl):Sxiv–Sxix
  11. Bracken MB, Holford TR. Effect of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological functions in NASCIS 2. J Neurosurg. 1993;79:500–507
  12. Hall ED, Springer JE. Neuroprotection and acute spinal cord injury: a reappraisal. NeuroRx. 2004;1:80–100
  13. Hurlbert RJ, Moulton R. Why do you prescribe methylprednisolone for acute spinal cord injury? (A Canadian perspective and position statement). Can J Neuro Sci. 2002;29:236–239
  14. Vellman WP, Hawkes AP, Lammertse DP. Administration of corticosteroids for acute spinal cord injury: the current practice of trauma medical directors and emergency medical system physician advisors. Spine. 2003;28:941–947
  15. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine. 2006;31:E250–E253

PII: S1934-1482(09)00549-8

doi: 10.1016/j.pmrj.2009.06.002

PM&R
Volume 1, Issue 7 , Pages 669-673 , July 2009

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