MASSIVE STEROIDS DO NOT REDUCE THE ZONE OF INJURY AFTER PENETRATING SPINAL-CORD INJURY

The National Acute Spinal Cord Injury Study II concluded in 1990 that high-dose methylprednisolone (MP) improved neurologic recovery after a cute spinal cord injury (ASCI). We tested this conclusion by analysis of 54 patients with ASCI; 25 patients were treated without MP before 1 990 whereas 29 patients were treated with MP after 1990. Neurologic de ficit was assessed regularly, in most cases daily. Motor and sensory s cores on admission, and best results at one-half week (days 2 to 4), 1 week (days 6 to 10), 2 weeks (days 11 to 21), 1 month, and 2 months w ere noted for both groups. Motor assessment was recorded in 22 muscle segments on a scale of 0 (complete deficit) to 5 (normal); the range, thus, was 0 to 110. The 23 patients with closed injuries demonstrated no difference in improvement with or without MP. In contrast, MP was a ssociated with impaired improvement in the patients with penetrating w ounds; the 15 patients with no MP therapy had an admission motor score of 49, which increased by 6.9 at one-half week, whereas the 16 patien ts treated with MP had an admission motor score of 48, which decreased by 0.3 at one-half week (p = 0.03). The neural status seen by day 4 p ersisted throughout the next 2 months. Changes in sensation paralleled the changes in motor function. We conclude that MP therapy for penetr ating ASCI may impair recovery of neurologic function.