A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate

dc.contributor.authorFehlings, Michael G.
dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorAarabi, Bizhan
dc.contributor.authorAnderson, Paul
dc.contributor.authorArnold, Paul M.
dc.contributor.authorBrodke, Darrel S.
dc.contributor.authorBurns, Anthony S.
dc.contributor.authorChiba, Kazuhiro
dc.contributor.authorDettori, Joseph R.
dc.contributor.authorFurlan, Julio C.
dc.contributor.authorHawryluk, Gregory
dc.contributor.authorHolly, Langston T.
dc.contributor.authorHowley, Susan
dc.contributor.authorJeji, Tara
dc.contributor.authorKalsi-Ryan, Sukhvinder
dc.contributor.authorKotter, Mark
dc.contributor.authorKurpad, Shekar
dc.contributor.authorKwon, Brian K.
dc.contributor.authorMarino, Ralph J.
dc.contributor.authorMartin, Allan R.
dc.contributor.authorMassicotte, Eric
dc.contributor.authorMerli, Geno
dc.contributor.authorMiddleton, James W.
dc.contributor.authorNakashima, Hiroaki
dc.contributor.authorNagoshi, Narihito
dc.contributor.authorPalmieri, Katherine
dc.contributor.authorSkelly, Andrea C.
dc.contributor.authorSingh, Anoushka
dc.contributor.authorTsai, Eve C.
dc.contributor.authorVaccaro, Alexander
dc.contributor.authorYee, Albert
dc.contributor.authorHarrop, James S.
dc.contributor.funderOntario Neurotrauma Foundation
dc.contributor.funderAmerican Association of Neurological Surgeons
dc.contributor.funderCongress of Neurological Surgeons
dc.contributor.funderGerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funderDeZwirek Family Foundation
dc.contributor.funderKrembil Foundation
dc.description.abstractIntroduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI." Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.identifier.citationFehlings, M. G., Wilson, J. R., Tetreault, L. A., Aarabi, B., Anderson, P., Arnold, P. M., Brodke, D. S., Burns, A. S., Chiba, K., Dettori, J. R., Furlan, J. C., Hawryluk, G., Holly, L. T., Howley, S., Jeji, T., Kalsi-Ryan, S., Kotter, M., Kurpad, S., Kwon, B. K., Marino, R. J., Martin, A. R., Massicotte, E., Merli, G., Middleton, J. W., Nakashima, H., Nagoshi, N., Palmieri, K., Skelly, A. C., Singh, A., Tsai, E. C., Vaccaro, A., Yee, A. and Harrop, J. S. (2017) 'A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate', Global Spine Journal, 7(3s), pp. 203-211. doi: 10.1177/2192568217703085en
dc.identifier.journaltitleGlobal Spine Journalen
dc.publisherSage Publicationsen
dc.rights© 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).en
dc.subjectSpinal cord injuryen
dc.subjectMethylprednisolone sodium succinateen
dc.subjectAcute spinal cord injuryen
dc.titleA clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinateen
dc.typeArticle (peer-reviewed)en
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