Remarkable Recovery After Delayed High-Dose Methylprednisolone in a Rare Case of Penetrating Spinal Cord Injury

Traumatic spinal cord injury (TSCI) caused by sharp-force penetration is exceptionally rare, and the use of high-dose methylprednisolone (MP) remains highly controversial, especially beyond the conventional 8-h treatment window. This case report describes a 30-year-old male with acute incomplete TSCI following a knife stab wound to the right neck. Despite no initial improvement, high-dose MP (1000 mg/day for 3 days, tapered thereafter) was initiated 40 h post-injury, along with mannitol. Remarkable neurological recovery was observed, including independent ambulation by post-injury day 25. Follow-up MRI showed significant hematoma absorption. This case suggests that delayed high-dose MP may benefit selected TSCI patients, particularly those with penetrating mechanisms and ongoing secondary injury. It highlights the potential for extending the therapeutic window in specific scenarios and supports the need for further research into individualized treatment strategies for TSCI.