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Review
. 2017 Sep;7(3 Suppl):116S-137S.
doi: 10.1177/2192568217706366. Epub 2017 Sep 5.

Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: A Systematic Review

Michael G Fehlings  1   2 , Jefferson R Wilson  2   3 , James S Harrop  4 , Brian K Kwon  5 , Lindsay A Tetreault  1   6 , Paul M Arnold  7 , Jeffrey M Singh  1 , Gregory Hawryluk  8 , Joseph R Dettori  9
Affiliations
Review

Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: A Systematic Review

Michael G Fehlings et al. Global Spine J. 2017 Sep.

Abstract

Study design: Systematic review and meta-analysis.

Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI).

Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated and evaluated using the Assessment of Multiple Systematic Reviews scoring system.

Results: The search yielded 723 citations, 13 of which satisfied inclusion criteria. Among these, 6 were primary research articles and 7 were previous systematic reviews. Based on the included research articles, there was moderate evidence that the 24-hour NASCIS II (National Acute Spinal Cord Injury Studies) MPSS regimen has no impact on long-term neurological recovery when all postinjury time points are considered. However, there is also moderate evidence that subjects receiving the same MPSS regimen within 8 hours of injury achieve an additional 3.2 points (95% confidence interval = 0.10 to 6.33; P = .04) of motor recovery compared with patients receiving placebo or no treatment.

Conclusion: Although safe to administer, a 24-hour NASCIS II MPSS regimen, when all postinjury time points are considered, has no impact on indices of long-term neurological recovery. When commenced within 8 hours of injury, however, a high-dose 24-hour regimen of MPSS confers a small positive benefit on long-term motor recovery and should be considered a treatment option for patients with SCI.

Keywords: MPSS; methylprednisolone sodium succinate; spinal cord injury; systematic review; traumatic spinal cord injury.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Literature search.
Figure 2.
Figure 2.
Motor scores, all patients. *Prospective cohort study with median follow-up of 127 and 117 days in the MPSS and control groups, respectively.
Figure 3.
Figure 3.
Pinprick, all patients.
Figure 4.
Figure 4.
Light touch, all patients.
Figure 5.
Figure 5.
Complications.
Figure 6.
Figure 6.
Timing of MPSS administration and motor scores.
Figure 7.
Figure 7.
Timing of MPSS administration and pinprick.
Figure 8.
Figure 8.
Timing of MPSS administration and light touch.
Figure 9.
Figure 9.
Motor score in patients treated within 8 hours at final follow-up of 6-12 months. *Evaniew had a median follow-up of 122 days
See this image and copyright information in PMC

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