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The impact of methylprednisolone on lesion severity following spinal cord injury
Bradley G Leypold1, Adam E Flanders, Eric D Schwartz
1Department of Radiology/Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Bradley.Leypold@mail.tju.edu
Study Design:
Retrospective study comparing spinal cord injury (SCI) lesion characteristics in methylprednisolone (MPS) treated versus untreated patients as demonstrated by magnetic resonance (MR) imaging.
Objective:
Determine if the administration of MPS immediately following SCI affects lesion severity.
Summary Of Background Data:
The administration of MPS in the setting of acute SCI has become controversial. Since magnetic resonance imaging (MRI) is sensitive for the detection of spinal cord edema and hemorrhage, changes in lesion characteristics would support a biologic effect due to MPS.
Methods:
Patients with cervical spinal injury treated with the recommended dose of methylprednisolone (bolus 30 mg/kg + 5.4 mg/kg per hour over 24 hours) initiated within 8 hours of injury were compared to historical controls that did not receive steroids. All patients (n = 82) sustained clinically complete SCI (ASIA Grade A) and underwent MRI on the same 1.5 Tesla unit. The length of spinal cord edema, presence/absence of intramedullary hemorrhage, and length of intramedullary hemorrhage were measured on T2-weighted and gradient echo MR images. Comparisons of lesion severity were then made between untreated and treated subjects.
Results:
Forty-eight of 82 patients with complete injuries received MPS therapy. After accounting for differences in the mean age of the treatment and control groups, multiple regression analysis demonstrated a persistent reduction in the mean length of intramedullary hemorrhage, 2.6 U in the treatment group versus 4.4 U in the control group (P = 0.04). Although there was a reduction in the number of patients exhibiting spinal cord hemorrhage in the treated group compared with the untreated group (65% vs. 91%), this result was not statistically significant (P = 0.16). There was no statistically significant effect of MPS treatment on the mean length of the spinal cord edema between treated versus untreated subjects (10.3 vs. 12.0, respectively, P = 0.85).
Conclusions:
MRI suggests MPS therapy in the acute phase of spinal cord injury may decrease the extent of intramedullary spinal cord hemorrhage.
Insights
Methylprednisolone (MPS) treatment after spinal cord injury (SCI) may reduce intramedullary hemorrhage extent. Magnetic resonance imaging (MRI) showed a significant decrease in hemorrhage length in treated patients, though effects on edema were not significant.
Area of Science:
- Neurosurgery
- Radiology
- Trauma Medicine
Background:
- The use of methylprednisolone (MPS) for acute spinal cord injury (SCI) is debated.
- Magnetic resonance imaging (MRI) can detect changes in spinal cord lesion characteristics, indicating a potential biological effect of MPS.
Purpose of the Study:
- To determine if methylprednisolone (MPS) administration immediately following spinal cord injury (SCI) impacts lesion severity.
- To evaluate the effect of MPS on lesion characteristics using MRI.
Main Methods:
- A retrospective study compared patients with cervical spinal injury who received MPS with historical controls who did not.
- MRI was used to measure spinal cord edema and intramedullary hemorrhage length in 82 patients (ASIA Grade A).
- Comparisons were made between MPS-treated and untreated subjects.
Main Results:
- MPS treatment was associated with a statistically significant reduction in the mean length of intramedullary hemorrhage (2.6 U vs. 4.4 U, P = 0.04).
- A trend towards fewer patients experiencing spinal cord hemorrhage in the MPS group was observed (65% vs. 91%, P = 0.16), but this was not statistically significant.
- No significant difference in the mean length of spinal cord edema was found between the MPS-treated and untreated groups (P = 0.85).
Conclusions:
- MRI findings suggest that methylprednisolone (MPS) therapy during the acute phase of spinal cord injury (SCI) may reduce the extent of intramedullary hemorrhage.
- The study indicates a potential benefit of MPS in mitigating hemorrhage severity in acute SCI.
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