title: Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry.
abstract: In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR). We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression. Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1-T1) rather than thoracolumbar (T2-L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02) NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.
authors.affiliation: 1 Division of Orthopaedics, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: 2 Rick Hansen Institute, Vancouver, Canada .|3 University of British Columbia , Vancouver, Canada .
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.affiliation: 2 Rick Hansen Institute, Vancouver, Canada .|3 University of British Columbia , Vancouver, Canada .
authors.forename: Nader
authors.initials: N
authors.lastname: Fallah
authors.affiliation: 3 University of British Columbia , Vancouver, Canada .
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
authors.affiliation: 2 Rick Hansen Institute, Vancouver, Canada .
authors.forename: Carly S
authors.initials: CS
authors.lastname: Rivers
authors.affiliation: 4 St. Michael's Hospital , Toronto, Ontario, Canada .|5 University of Toronto Spine Program, University of Toronto , Ontario, Canada .
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.affiliation: 6 Division of Orthopaedic Surgery, Western University ; London Health Services Centre, London, Ontario, Canada .
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bailey
authors.affiliation: 7 Division of Neurosurgery-Halifax Infirmary, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Sean D
authors.initials: SD
authors.lastname: Christie
authors.affiliation: 8 Department of Surgery, University of Saskatchewan , Saskatoon, Saskatchewan, Canada .
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.affiliation: 9 University of Calgary Spine Program , Calgary, Alberta, Canada .
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.affiliation: 10 Department of Physical Medicine and Rehabilitation, University of Saskatchewan , Saskatoon, Saskatchewan, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: Linassi
authors.affiliation: 5 University of Toronto Spine Program, University of Toronto , Ontario, Canada .|11 Division of Neurosurgery, University of Toronto , Ontario, Canada .
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: 3 University of British Columbia , Vancouver, Canada .
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D020127:Recovery of Function / Q000187:drug effects*; D012042:Registries; D013119:Spinal Cord Injuries / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: methylprednisolone; motor score; neurological recovery; propensity scored-matched; spinal cord injury