Urgent surgical decompression compared to methylprednisolone for the treatment of acute spinal cord injury: a randomized prospective study in beagle dogs.
METHODS
Experimental dog model of acute spinal cord injury.


OBJECTIVE
To compare the relative value of methylprednisolone, surgical decompression, or both for the treatment of traumatic spinal cord injury.


BACKGROUND
Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events, which leads to further damage. Surgical decompression is known to improve clinical outcomes, but the timing of surgical decompression remains controversial.


METHODS
A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs. The animals were then prospectively randomized to 3 groups: 1) surgical decompression at 6 hours and intravenous methylprednisolone; 2) surgical decompression at 6 hours and intravenous saline; and 3) intravenous methylprednisolone without surgical decompression. Each animal was evaluated by somatosensory-evoked potentials, daily neurologic assessment, and histologic examination at 2 weeks following injury.


RESULTS
Immediately following spinal cord constriction, all animals were paraplegic, incontinent, and the somatosensory-evoked potentials were abolished. Surgical decompression 6 hours after injury, with or without methylprednisolone, led to significantly better neurologic function at 2 weeks than methylprednisolone alone.


CONCLUSIONS
In the setting of acute and persistent spinal cord compression in beagle dogs, surgical decompression 6 hours after injury, with or without methylprednisolone, is more effective for improving neurologic recovery than methylprednisolone alone.
Rabinowitz
Richard S
RS
Barrington Orthopaedic Associates, Hoffman Estates, IL, USA.
Eck
Jason C
JC
Harper
C Michel
CM
Larson
Dirk R
DR
Jimenez
Miguel A
MA
Parisi
Joseph E
JE
Friedman
Jonathan A
JA
Yaszemski
Michael J
MJ
Currier
Bradford L
BL
D000208:Acute Disease; D000818:Animals; D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D004195:Disease Models, Animal; D004285:Dogs; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D008775:Methylprednisolone