In 1990, the Second National Acute
Spinal Cord Injury Study reported that high-dosage
methylprednisolone improves neurologic recovery in spinal-injured humans. The study showed that patients who received the
drug within 8 hr after injury improved, whereas those who received the
drug later did not. The
drug significantly increased recovery even in severely injured patients who were admitted with no motor or sensory function below the lesion, contradicting a long-held dogma that such patients would not recover. Some researchers, however, have questioned the stratification of the patient population, the use of summed neurologic change scores, and the absence of functional assessments. The stratification by injury severity and treatment time was planned a priori and based on objective criteria. Detailed analyses revealed no differences between groups attributable to stratification or randomization. While multivariate analyses of the summed neurologic scores were used, the conclusions were corroborated by other analytical approaches that did not rely on summed scores. For example, treatment with
methylprednisolone more than doubled the probability that patients would convert from
quadriplegia or
paraplegia to
quadriparesis or
paraparesis,
analgesia to hypalgesia, and
anesthesia to
hypesthesia. The treatment also significantly improved neurologic scores in lumbosacral segments, indicating that beneficial effects were not limited to segments close to the lesion site. The treatment did not significantly affect mortality or morbidity. The study strongly suggests that
methylprednisolone has significant beneficial effects in human
spinal cord injury, that these effects occur only when the
drug is given within 8 hr, and that it helps even in patients with severe
spinal cord injuries. These conclusions have important implications for
spinal cord injury care and research.