Effectiveness of methylprednisolone in acute spinal cord injury - A systematic review of randomized controlled trials

Abstract

Steroid therapy has been tested as a neuronal protector in spinal cord injury. Multicenter studies evaluating the efficacy of methylprednisolone (MP) in posttraumatic neurological recovery have shown promising results (NASCIS). However, several critical studies related to NASCIS results have been published. Objective. To review the literature concerning the use of methylprednisolone compared with placebo. MethOds. This analysis added the mean improvement obtained by groups of patients using MP and placebo (PL) to their mean scores at baseline, before treatment, resulting in the final neurological outcome for both groups. Results. The motor score in the MP group was only 2.5 points higher than in the PL group after a one-year follow-up. In neurologically intact individuals, the motor score is 70 points. Improvement in sensory scores was also discrete (1.1 and 1.7 points for pinprick and light touch sensation, respectively). A high rate of complications was observed in a group of patients aged about 60 years who used MP. Conclusion. Differences in the clinical magnitude of the benefits obtained (not confirmed by other studies) with the use of MP and PL are not significant against the potential complications when using this medication.