Early Complications of High-Dose Methylprednisolone Sodium Succinate Treatment in the Follow-Up of Acute Cervical Spinal Cord Injury

Abstract

Aged patients with cervical spinal injury may be more likely to have pulmonary side effects (P = 0.029) after high-dose therapy with MPSS and thus deserve special care.

Effect of postinjury intravenous or intrathecal methylprednisolone on spinal cord excitatory amino-acid release, nitric oxide generation, PGE2 synthesis, and myeloperoxidase content in a pig model of acute spinal cord injury

“…In particular, the incidence of wound infection, sepsis, pneumonia, and the duration of intensive care unit stay have all been increased in patients receiving high-dose methylprednisolone. 13,15,20,[46][47][48][49] Intravenous methylprednisolone must be administered in such high doses because, as we have previously shown, methylprednisolone entry into the central nervous system is actively opposed by P-glycoprotein present in the capillary endothelial cells comprising the brain-and spinal cord-blood barriers. 50 As P-glycoprotein actively pumps methylprednisolone out of the central nervous system, systemically administered methylprednisolone must be given in very high doses to overwhelm the efflux pump's capacity and to achieve reasonable concentrations in the central nervous system.…”

Acute Management of Spinal Cord Injury at the Out-of-Hospital and Emergency Department Settings

“…After this study, the use of intravenous high-dose methylprednisolone became a standard approach in acute management of SCI patients (47). However, two other studies reported that high-dose methylprednisolone could be associated increased complication rates (48,49).…”

Clinical trials in spinal cord injury: lessons learned on the path to translation. The 2011 International Spinal Cord Society Sir Ludwig Guttmann Lecture

“…16,17 At the same time, the safety of MP treatment was being challenged by the publication of a number of non-randomized case series reports, suggesting an association between treatment and immune system compromise, pneumonia, mechanical ventilation days, gastrointestinal complications and myopathy. [18][19][20][21] The Great Debate: the quality of NASCIS evidence While the debate over the validity of NASCIS 2 and 3 conclusions may have been motivated by many factors including timing of the public dissemination, and feelings that a far-reaching standard had been imposed without proper vetting, the substance of the argument revolved around the quality of the evidence. While a thorough review of the various positions is well beyond the scope of this communication, the interested reader is encouraged to consult the abundant literature on the topic that has been published over the past 20 years.…”