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High-Dose Methylprednisolone for Acute Closed Spinal Cord Injury - Only a Treatment Option

Published online by Cambridge University Press:  02 December 2014

H. Hugenholtz
Affiliation:
QEII Health Sciences, Halifax, NS, Canada
D.E. Cass
Affiliation:
St. Michael’s Hospital, Toronto, ON, Canada
M.F. Dvorak
Affiliation:
Vancouver General Hospital, Vancouver, BC, Canada
D.H. Fewer
Affiliation:
St. Boniface General, Hospital, Winnipeg, MB, Canada
R.J. Fox
Affiliation:
University Hospital, Edmonton, AB, Canada
D.M.S. Izukawa
Affiliation:
Trillium, Health Centre, Mississauga, ON, Canada
J. Lexchin
Affiliation:
Toronto Hospital, Toronto, ON, Canada
S. Tuli
Affiliation:
Sunnybrook Health, Science Centre, Toronto, ON, Canada
N. Bharatwal
Affiliation:
Toronto Rehabilitation, Toronto, ON, Canada
C. Short
Affiliation:
Nova Scotia, Rehabilitation Centre, Halifax, NS, Canada
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Abstract

Background:

A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment.

Methods:

A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus.

Results:

One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy.

Conclusion:

There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of bodyweight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I- to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option.

Résumé:

RÉSUMÉ: Introduction:

Une revue systématique des données concernant l’infusion de méthylprednisolone suite à un traumatisme aigu de la moelle épinière a été effectuée afin de clarifier la confusion qui règne sur l’utilité de ce traitement

Méthodes:

Un comité formé de spécialistes en neurochirurgie et en chirurgie orthopédique de la colonne vertébrale, d’urgentologues et de physiatres en pratique clinique active a procédé à une recherche électronique de bases de données pour identifier des articles sur les traumatismes aigus de la moelle épinière et l’administration de stéroïdes, du 1er janvier 1966 à avril 2001. Une recherché manuelle de listes de références, la quête d’informations additionnelles non publiées, la traduction de références en langues étrangères et le protocole d’étude de l’auteur d’une Cochrane systematic review et de Pharmacia inc. ont été utilisés comme sources d’informations d’appoint. Les données ont été pondérées et des recommandations ont été développées par consensus.

Résultats:

Cent cinquante-sept citations qui traitaient spécifiquement de traumatisme de la moelle épinière et de méthylprednisolone ont été identifiées et soixante-quatre ont été revues. Les recommandations ont été basées sur une revue systématique Cochrane, six études cliniques de niveau I et sept études de niveau II qui traitaient de modifications de la function neurologique et de complications suite au traitement par la méthylprednisolone.

Conclusions:

Il n’y a pas suffisamment de données pour appuyer l’utilisation de la méthylprednisolone à haute dose en dedans de huit heures après un traumatisme aigu fermé de la moelle épinière comme traitement standard ou comme ligne directrice de traitement. La méthylprednisolone prescrite en infusion intraveineuse en bolus de 30 mg par kilogramme de poids corporel sur une période de quinze minutes en dedans de huit heures d’un traumatisme fermé de la moelle, suivie 45 minutes plus tard d’une infusion de 5,4 mg par kilogramme de poids à l’heure pendant 23 heures est seulement une option thérapeutique en faveur de laquelle il n’y a que des données cliniques faibles (Niveau I à II-1). Il n’y a pas suffisamment de données pour recommander de prolonger l’infusion de éthylprednisolone au delà de vingt-trois heures si on choisit cette option thérapeutique.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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