Efficacy of methylprednisolone in acute spinal cord injury
M. B. Bracken, W. F. Collins, D. F. Freeman, M. J. Shepard, F. W. Wagner, R. M. Silten, K. G. Hellenbrand, J. Ransohoff, W. E. Hunt, P. L. Perot Jr and al. et
A multicenter double-blind randomized trial was conducted to examine the
efficacy of a high dose of methylprednisolone (1,000-mg bolus and daily
thereafter for ten days) compared with a standard dose (100-mg bolus and
daily thereafter for ten days) in 330 patients with acute spinal cord
injury. No difference in neurological recovery of motor function or
pinprick and light touch sensation was observed between the two treatment
groups six weeks and six months after injury. The lack of a treatment
effect was independent of the severity of the initial lesion or the time
from injury to starting treatment. Although not statistically significant,
early case fatality was greater in the high-dose protocol (relative risk of
3.1 and 1.9, less than or equal to 14 and 15 to 28 days after injury,
respectively) but not from 29 to 210 days after injury. Wound infections of
both trauma and operative sites were more prevalent in the high-dose
regimen (relative risk of 3.6).
