USE OF METHYLPREDNISOLONE AS AN ADJUNCT IN THE MANAGEMENT OF PATIENTSWITH PENETRATING SPINAL-CORD INJURY - OUTCOME ANALYSIS

OBJECTIVE: Since the results of the Second National Acute Spinal Cord Injury Study were published in 1990, methylprednisolone has become a m ainstay in the treatment of nonpenetrating spinal cord injury. Althoug h potential significant relationships between the prompt administratio n of high-dose methylprednisolone after blunt spinal cord injury and o utcome have recently been addressed, the relationship between the prom pt administration of high-dose methylprednisolone after penetrating sp inal cord injury and outcome remain unanswered. METHODS: To explore th is relationship, we performed a retrospective nonrandomized study on a series of 252 patients with penetrating missile injuries to the spine who presented to our institution from March 1980 to July 1993. One hu ndred eighty-one patients (71%) were treated conventionally without ad junctive steroid therapy before 1990. Sixteen patients followed up dur ing the 13-year study period received steroid protocols that were not consistent with the Second National Acute Spinal Cord Injury Study pro tocol and were excluded from the study. Since 1990, 55 patients (21%) were treated with intravenous methylprednisolone according to the Seco nd National Acute Spinal Cord Injury Study protocol. All patients were subsequently transferred for rehabilitative care, and prospective eva luations of their neurological status were performed at admission and discharge. RESULTS: The study included 236 men and 16 women (mean age, 25.6 yr). The mean duration of stay for initial hospitalization was 9 4.6 days, and the mean duration of stay in rehabilitation was 78.6 day s. Frankel scores were used to assess outcome (P < 0.05) and were asse ssed at admission and at the time of definitive discharge from the Spi nal Cord Injury Care System. The hypothesis that methylprednisolone th erapy significantly improves functional outcomes in patients with guns hot wound injuries to the spine was rejected. Only the total number of days in rehabilitation and the degree of neurological injury at admis sion contributed significantly to explaining outcome at discharge. CON CLUSION: The administration of methylprednisolone did not significantl y improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by pa tients during their hospitalizations.