الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Traumatic spinal cord injuries (TSCIs) affect up to 500,000 people worldwide each year, and their high morbidity is associated with substantial individual and societal burden and socio-economic impact. Patients with TSCIs often experience devastating neurological impairments, and they frequently require complex long-term multidisciplinary care.
Despite these significant but incremental advancements, the history of SCI-related research has also been laden with substantial disappointment. Specifically, although over a dozen clinical trials have been completed, investigating many promising neuroprotective and neuroregenerative pharmacological therapies, no drug has been accepted as standard of care.
Anaesthesiologists, surgeons, and critical care providers continue to face the dilemma of glucocorticoid use in the management of acute traumatic spinal cord injury (ATSCI). Of the drug therapies examined in clinical trials to date, methylprednisolone (MPSS), theorized to thwart peroxidation of neuronal membrane lipids early in the secondary injury cascade post-SCI. Early MPSS therapy is considered to be one of the few treatments with potential clinical benefit for ATSCI; however, its use is controversial.
The aim of this study was to evaluate the effect of early administration of methylprednisolone sodium succinate (MPSS) at ED on neurological improvement following incomplete acute traumatic spinal cord injury (ATSCI).
In this study, 40 patients with incomplete ATSCI were enrolled. All patients were randomly (Scientific Randomization sheet available from Randomizer.org) assigned to 2 treatment groups. MPSS group; (n=20) patients received methylprednisolone sodium succinate (MPSS) at ED as initial bolus of 30 mg/kg followed by maintenance infusion of 5.4 mg/kg/hour for 23 hours. Control group; (n=20) patients didn’t receive MPSS. The measured outcome was the neurological improvement using ASIA Impairment Scale (AIS) at 2 time points (6 weeks and 6 months after injury).
Results showed that there were no any statistically significant differences between the 2 groups in their AIS after 6 weeks (p=0.962) or 6 months (p=0.946). MPSS was not associated with significant improvement in late neurological outcomes.
We concluded that early administration of high-dose IV methylprednisolone sodium succinate (MPSS) at emergency department (ED) in patients with incomplete acute traumatic spinal cord injury (ATSCI) might be associated with neurological improvement, measured as ASIA Impairment Scale (AIS) at 6 weeks and 6 months but it was not statistically significant.
Our recommendations are, larger multicentric studies should be conducted. The neurological improvement should be studied after subgroup analysis with respect to the age and initial ASIA impairment scale.