Study questions methylprednisolone use for treatment of patients with traumatic SCIs

Most Canadian surgeons have stopped using the steroid to treat the acute spinal cord injuries, according to an investigator.

Methylprednisolone used according to the NASCIS-II protocol to treat patients with acute traumatic spinal cord injuries resulted in more complications and did not improve motor score recovery compared with patients who did not receive the steroid, according to results of a comparative study published in the Journal of Neurotrauma.

Investigator Michael G. Fehlings, MD, PhD, FRCSC, FACS, said despite the small number of patients who received methylprednisolone in the study, the results support the guideline recommendations against routine administration of methylprednisolone in acute traumatic spinal cord injuries (SCIs).

“The bottom line is currently, in the Canadian context, methylprednisolone is essentially not being used. One needs to be careful with such a small number of patients who have received methylprednisolone to make any inferences around efficacy. However, what the study did show was in this small group of patients, there did not appear to be any significant added benefit of using methylprednisolone, but the caveat though, of course, is it is a very small number of patients who actually received methylprednisolone,” he told Spine Surgery Today.

Fewer patients treated with steroids

Fehlings, who is a Spine Surgery Today Editorial Board member, and colleagues retrospectively analyzed prospectively collected data from participants in the Rick Hansen Spinal Cord Injury Registry. They included 46 patients who received methylprednisolone to treat an acute traumatic SCI and 1,555 patients who received no steroid treatment for the same injury.

Michael G. Fehlings

There were no statistical differences between matched cohorts for total, upper extremity or lower extremity motor recovery at final follow-up, as well as no in-hospital mortality in the two groups.

Motor score recovery unaffected

Using a multivariate model, cervical injury levels (C1-T1) were associated with greater motor score recovery (P < .01). The investigators found reduced baseline injury severity and thoracolumbar injury levels were not associated with greater motor score recovery.

A total of 61% of patients who received the steroids developed a complication, which was statistically significantly different from the 36% of patient who received no steroids and developed a complication (P = .02).

Despite the higher complication rates and overall similarities in motor recovery for the steroid group, Fehlings said steroid treatments may be useful in select patients.

“Essentially what occurred in the Canadian context is most surgeons have stopped using methylprednisolone, and this really reflects that. What the study also suggests is that spinal cord injury is heterogeneous, and there is a possibility that there might be specific cohorts of patients that could still benefit from methylprednisolone, but overall this probably will not be recommended as a routine management strategy,” Fehlings said.

Based on data from this study an additional research question is being looked at by AOSpine America and AOSpine International to examine a possible role for methylprednisolone in patients with isolated cervical spinal cord injuries.

“There is some suggestion that patients with cervical spinal cord injuries, particularly if they undergo early surgery, might represent a subgroup in which steroids could have an added benefit,” Fehlings said. – by Robert Linnehan

Reference:
Evaniew N, et al. J Neurotrauma. 2015;doi:10.1089/neu.2015.3963.

For more information:
Michael G. Fehlings, MD, PhD, FRCSC, FACS, can be reached at Toronto Western Hospital, West Wing, 4th Floor, Room 4WW449, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8; email: michael.fehlings@uhn.ca.

Disclosure: Fehlings reports no relevant financial disclosures.