Use of Methylprednisolone as an Adjunct in the Management of Patients with Penetrating Spinal Cord Injury: Outcome Analysis

Levy, Michael L.; Gans, William; Wijesinghe, Hiran S.; SooHoo, Wayne E.; Adkins, Rodney H.; Stillerman, Charles B.

doi:10.1097/00006123-199612000-00014

Cited by 111 publications

(54 citation statements)

References 10 publications

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“…Complete deficit was reported to be more dependent on spinal injury level, violation of bone architecture by the bullet, and presence of a bullet in the canal. Based on data from 10 studies, CGSWSCI rate at the cervical level was 30% (315 of 1055), at the thoracic level was 49% (518 of 1055), and at the lumbosacral level was 21% (222 of 1055) [13,[17][18][19][20][21][22][23][24][25]. Of the cervical SCIs, two studies examining gunshot injuries to the cervical spine reported the rate of complete injury to be approximately 70% (46 of 66) [26,27].…”

Section: Resultsmentioning

confidence: 99%

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Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

129

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Background The principles that guide management of spinal cord injury (SCI) derive from injury resulting from blunt trauma, not gunshot wounds. Civilian gunshot-induced spinal cord injury (CGSWSCI) is a common, potentially serious cause of neurological deficit; there is disagreement about whether the same approaches used for SCI caused by blunt-force trauma should apply to gunshot-induced SCI. Questions/purposes We reviewed the literature to answer the following questions regarding presentation and outcome of gunshot wound-induced SCI: (1) Are there differences in recovery prognosis between complete SCI and other patterns of SCI in CGSWSCI. (2) Does the use of steroids improve neurological recovery? (3) Does surgery to remove the bullet affect neurological recovery in CGSWSCI? (4) Does surgery result in an increased risk of complications of treatment? Methods We performed a systematic literature review of articles related to civilian gunshot injuries to the spine. Information relating to incidence, pattern of neurological injury, associated injuries, treatment, neurological outcome, and associated complications was extracted. Three independent reviewers assessed the strength of evidence present in the literature by examining quality, quantity, and consistency of results.

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Section: Resultsmentioning

confidence: 99%

“…Steroid administration was documented in four studies, three of which reported the association with neurological recovery [18,20,23]. Overall, no major clinical benefit was demonstrated with steroid administration.…”

Section: Resultsmentioning

confidence: 99%

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

129

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“…There is also no role for the administration of trauma-dose Solu-Medrol in these patients. 26 The only absolute indications for surgery are to repair a CSF-cutaneous/pleural fistula or if the patient has progressive neurological decline correlated with compression of neural elements on imaging studies.…”

Section: Our Recommendations For Deployed Military Neurosurgeonsmentioning

confidence: 99%

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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Neurosurg Focus 28 (5):E4, 20101 P atients with PSIs present very complex, multidisciplinary management challenges for military surgeons. Not only can the patient have immediate and delayed life-threatening damage to organs along the path of the projectile, the spinal column and possibly the neurological structures contained within can also, by definition, suffer injury, the severity of which depends on multiple factors. Spinal cord injury from spinal GSWs is more often a complete lesion with a decreased potential for neurological recovery than with closed trauma. 43There are a number of potential surgical indications, the most controversial of which is whether decompressive laminectomy has any effect on neurological recovery. Medical civilian and military literature is replete with opinions for and against the use of surgery.Although missile characteristics such as size, composition and design are important, the major determinant of the destructive ability of a projectile is velocity at impact and thus the kinetic energy imparted to the surrounding tissue.10 Energy is calculated based on mass and velocity as follows: energy = 1/2mv 2 . Therefore, velocity has a significantly greater effect on energy than projectile mass. Object. Penetrating spinal injury (PSI), although an infrequent injury in the civilian population, is not an infrequent injury in military conflicts. Throughout military history, the role of surgery in the treatment of PSI has been controversial. The US is currently involved in 2 military campaigns, the hallmark of both being the widespread use of various explosive devices. The authors reviewed the evidence for or against the use of decompressive laminectomy to treat PSI to provide a triservice (US Army, Navy, and Air Force) consensus and treatment recommendations for military neurosurgeons and spine surgeons.Methods. A US National Library of Medicine PubMed database search that identified all literature dealing with acute management of PSI from military conflicts and civilian urban trauma centers in the post-Vietnam War period was undertaken.Results. Nineteen retrospective case series (11 military and 8 civilian) met the study criteria. Eleven military articles covered a 20-year time span that included 782 patients who suffered either gunshot or blast-related projectile wounds. Four papers included sufficient data that analyzed the effectiveness of surgery compared with nonoperative management, 6 papers concluded that surgery was of no benefit, 2 papers indicated that surgery did have a role, and 3 papers made no comment. Eight civilian articles covered a 9-year time span that included 653 patients with spinal gunshot wounds. Two articles lacked any comparative data because of treatment bias. Two papers concluded that decompressive laminectomy had a beneficial role, 1 paper favored the removal of intracanal bullets between T-12 and L-4, and 5 papers indicated that surgery was of no benefit.Conclusions. Based on the authors' military and civilian PubMed literature search, most of the evidence s...

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“…50,51 Administration of methylprednisolone had a high incidence of pancreatitis, while dexamethasone had the highest GIT complication rate. 51 Heiden et al reported that the outcome and potential for recovery depended on the initial injury, and that surgical intervention did not alter neurological outcome, in either complete or incomplete patients.…”

Section: Neurological Injurymentioning

confidence: 99%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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Use of Methylprednisolone as an Adjunct in the Management of Patients with Penetrating Spinal Cord Injury: Outcome Analysis

Abstract: The administration of methylprednisolone did not significantly improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by patients during their hospitalizations.

Cited by 111 publications

References 10 publications

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Civilian gunshot wounds of the spine: A literature review

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