Urgent surgical decompression compared to methylprednisolone for the treatment of acute spinal cord injury: a randomized prospective study in beagle dogs
Department of Orthopedics and Physical Rehabilitation
Medical Subject Headings
Acute Disease; Animals; Combined Modality Therapy; *Decompression, Surgical; *Disease Models, Animal; Dogs; Male; Methylprednisolone; Prospective Studies; Spinal Cord Injuries; Time Factors; Treatment Outcome
Orthopedics | Rehabilitation and Therapy
STUDY DESIGN: Experimental dog model of acute spinal cord injury.
OBJECTIVE: To compare the relative value of methylprednisolone, surgical decompression, or both for the treatment of traumatic spinal cord injury.
SUMMARY OF BACKGROUND DATA: Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events, which leads to further damage. Surgical decompression is known to improve clinical outcomes, but the timing of surgical decompression remains controversial.
METHODS: A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs. The animals were then prospectively randomized to 3 groups: 1) surgical decompression at 6 hours and intravenous methylprednisolone; 2) surgical decompression at 6 hours and intravenous saline; and 3) intravenous methylprednisolone without surgical decompression. Each animal was evaluated by somatosensory-evoked potentials, daily neurologic assessment, and histologic examination at 2 weeks following injury.
RESULTS: Immediately following spinal cord constriction, all animals were paraplegic, incontinent, and the somatosensory-evoked potentials were abolished. Surgical decompression 6 hours after injury, with or without methylprednisolone, led to significantly better neurologic function at 2 weeks than methylprednisolone alone.
CONCLUSION: In the setting of acute and persistent spinal cord compression in beagle dogs, surgical decompression 6 hours after injury, with or without methylprednisolone, is more effective for improving neurologic recovery than methylprednisolone alone.
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Citation: Spine (Phila Pa 1976). 2008 Oct 1;33(21):2260-8. Link to article on publisher's site