Urgent Surgical Decompression Compared to Methylprednisolone for the Treatment of Acute Spinal Cord Injury

In Brief 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. We compared the relative value of methylprednisolone, surgical decompression, or both for the treatment of acute compressive spinal cord injury in dogs. Decompression was performed 6 hours following placement of a constrictive band that reduced the volume of the spinal canal by 60%. Neurologic outcome was significantly better with surgical decompression with or without methylprednisolone than treatment with methylprednisolone alone.