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Does Intra-Operative Methylprednisolone Improve Outcomes of Surgery for Degenerative Cervical Myelopathy? - A
Saumyajit Basu1, Kushal Gohil2, Sanjit Singh3
1Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India.
Global Spine Journal
|December 13, 2024
Summary
Intraoperative Methylprednisolone (MP) in decompressive surgery for DCM showed no significant clinical improvement but improved MRI outcomes. This steroid administration was safe and suggested potential neuroprotective benefits for spinal cord recovery.
Area of Science:
- Neurosurgery
- Neurology
- Pharmacology
Background:
- Degenerative cervical myelopathy (DCM) impacts neurological function, necessitating surgical decompression.
- Neuroinflammation following surgery can affect patient outcomes.
- Methylprednisolone (MP) is a steroid with anti-inflammatory properties.
Purpose of the Study:
- To evaluate the efficacy of intraoperative fixed-dose intravenous Methylprednisolone (MP) in reducing neuroinflammation and improving functional and radiological outcomes in patients undergoing decompressive surgery for DCM.
- Primary objectives included assessing the impact of MP on modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and MRI signal changes.
Main Methods:
- A prospective, triple-blinded, randomized controlled trial was conducted with 65 patients.
- Patients were allocated to receive either intraoperative MP (1g) or a placebo.
- Clinical outcomes (mJOA, Nurick grade, recovery rates) and radiological outcomes (MRI signal changes via Chen's grading) were assessed at 1, 3, and 24 months post-surgery.
Main Results:
- The MP group showed a trend towards greater mJOA score improvement at 24 months, but this was not statistically significant (P = .107).
- Moderate effect sizes were observed for mJOA and Nurick recovery rates at 1 and 3 months, though not statistically significant.
- Significantly better radiological outcomes, indicated by reduced spinal cord signal changes on MRI (Chen's grading), were observed in the MP group at 24 months (P = .038).
- Complication rates were similar between the MP and control groups.
Conclusions:
- Intraoperative MP administration in DCM surgery did not meet the primary hypothesis for significant clinical improvement but demonstrated safety.
- The study suggests potential neuroprotective benefits of MP, evidenced by improved MRI outcomes and a trend in clinical recovery.
- Larger, multicenter studies are recommended to validate these findings and determine optimal dosing for MP in DCM surgery.
