DOI: 10.3171/jns.1998.89.5.0699. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up

Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up

10.3171/jns.1998.89.5.0699

Crossref journal-article

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of Neurosurgery (1754)

Abstract

Object. A randomized double-blind clinical trial was conducted to compare neurological and functional recovery and morbidity and mortality rates 1 year after acute spinal cord injury in patients who had received a standard 24-hour methylprednisolone regimen (24MP) with those in whom an identical MP regimen had been delivered for 48 hours (48MP) or those who had received a 48-hour tirilazad mesylate (48TM) regimen. Methods. Patients for whom treatment was initiated within 3 hours of injury showed equal neurological and functional recovery in all three treatment groups. Patients for whom treatment was delayed more than 3 hours experienced diminished motor function recovery in the 24MP group, but those in the 48MP group showed greater 1-year motor recovery (recovery scores of 13.7 and 19, respectively, p = 0.053). A greater percentage of patients improving three or more neurological grades was also observed in the 48MP group (p = 0.073). In general, patients treated with 48TM recovered equally when compared with those who received 24MP treatments. A corresponding recovery in self care and sphincter control was seen but was not statistically significant. Mortality and morbidity rates at 1 year were similar in all groups. Conclusions. For patients in whom MP therapy is initiated within 3 hours of injury, 24-hour maintenance is appropriate. Patients starting therapy 3 to 8 hours after injury should be maintained on the regimen for 48 hours unless there are complicating medical factors.

Bibliography

Bracken, M. B., Shepard, M. J., Holford, T. R., Leo-Summers, L., Aldrich, E. F., Fazl, M., Fehlings, M. G., Herr, D. L., Hitchon, P. W., Marshall, L. F., Nockels, R. P., Pascale, V., Perot, P. L., Piepmeier, J., Sonntag, V. K. H., Wagner, F., Wilberger, J. E., Winn, H. R., & Young, W. (1998). Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Journal of Neurosurgery, 89(5), 699â706.

Authors 19

Michael B. Bracken (first)
Mary Jo Shepard (additional)
Theodore R. Holford (additional)
Linda Leo-Summers (additional)
E. Francois Aldrich (additional)
Mahmood Fazl (additional)
Michael G. Fehlings (additional)
Daniel L. Herr (additional)
Patrick W. Hitchon (additional)
Lawrence F. Marshall (additional)
Russ P. Nockels (additional)
Valentine Pascale (additional)
Phanor L. Perot (additional)
Joseph Piepmeier (additional)
Volker K. H. Sonntag (additional)
Franklin Wagner (additional)
Jack E. Wilberger (additional)
H. Richard Winn (additional)
Wise Young (additional)

References 31 Referenced 414

{'key': 'b1', 'volume-title': 'Standards for Neurological and Functional Classification of Spinal Cord Injury, rev ed.', 'author': 'American Spinal Injury Association', 'year': '1992'} / Standards for Neurological and Functional Classification of Spinal Cord Injury, rev ed. by American Spinal Injury Association (1992)
10.3171/jns.1988.69.4.0562
10.1016/0006-8993(94)91224-6
10.1089/neu.1991.8.187
10.1001/jama.251.1.45
10.3171/jns.1993.79.4.0500
10.1056/NEJM199005173222001
10.3171/jns.1992.76.1.0023
10.3171/jns.1985.63.5.0704
10.1001/jama.277.20.1597
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10.3171/jns.1983.59.2.0256
10.3171/jns.1987.67.1.0102
10.3171/jns.1994.80.1.0097
{'key': 'b15', 'first-page': '91', 'volume': '492', 'author': 'Demopoulos HB', 'year': '1980', 'journal-title': 'Acta Physiol Scand Suppl'} / Acta Physiol Scand Suppl by Demopoulos HB (1980)
10.3171/jns.1988.68.3.0462
10.1007/BF00711581 / Cell Mol Neurobiol by Hall ED (1993)
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{'key': 'b19', 'first-page': '206', 'volume-title': 'Steroids and Neuronal Activity. Ciba Foundation Symposium', 'volume': '153', 'author': 'Hall ED', 'year': '1990'} / Steroids and Neuronal Activity. Ciba Foundation Symposium by Hall ED (1990)
{'key': 'b20', 'first-page': '81', 'volume': '71', 'author': 'Hall ED', 'year': '1993', 'journal-title': 'Res Publ Assoc Res Nerv Ment Dis'} / Res Publ Assoc Res Nerv Ment Dis by Hall ED (1993)
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10.1080/01616412.1992.11740010 / Neurol Res by Holtz A (1992)
10.1089/neu.1990.7.115
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10.1172/JCI112865 / J Clin Invest by Sadrzadeh SMH (1987)
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10.1089/neu.1992.9.245

Dates

Type	When
Created	16 years, 2 months ago (June 15, 2009, 10:19 p.m.)
Deposited	3 years, 3 months ago (May 27, 2022, 11:31 p.m.)
Indexed	1 day, 16 hours ago (Aug. 30, 2025, 12:25 p.m.)
Issued	26 years, 10 months ago (Nov. 1, 1998)
Published	26 years, 10 months ago (Nov. 1, 1998)
Published Print	26 years, 10 months ago (Nov. 1, 1998)

Funders 0

None

BibTeX

@article{Bracken_1998, title={Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up: Results of the third National Acute Spinal Cord Injury Randomized Controlled Trial}, volume={89}, ISSN={0022-3085}, url={http://dx.doi.org/10.3171/jns.1998.89.5.0699}, DOI={10.3171/jns.1998.89.5.0699}, number={5}, journal={Journal of Neurosurgery}, publisher={Journal of Neurosurgery Publishing Group (JNSPG)}, author={Bracken, Michael B. and Shepard, Mary Jo and Holford, Theodore R. and Leo-Summers, Linda and Aldrich, E. Francois and Fazl, Mahmood and Fehlings, Michael G. and Herr, Daniel L. and Hitchon, Patrick W. and Marshall, Lawrence F. and Nockels, Russ P. and Pascale, Valentine and Perot, Phanor L. and Piepmeier, Joseph and Sonntag, Volker K. H. and Wagner, Franklin and Wilberger, Jack E. and Winn, H. Richard and Young, Wise}, year={1998}, month=nov, pages={699–706} }

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