Effect of Low-dose Methylprednisolone in Promoting Neurological Function Recovery After Spinal Cord Injury

STUDY DESIGN: Subgroup analysis of a retrospective clinical and animal trial [study of different doses of methylprednisolone (MP) on functional recovery of spinal cord injury (SCI)]. OBJECTIVE: The aim is to investigate the efficacy of low-dose MP regimens in promoting neural repair after SCI. BACKGROUND: SCI can result in sensory, motor, and autonomic nerve dysfunction, often leading to disability or death. MP is a preferred medication for the clinical treatment of SCI. Low-dose regimen may be a safer and more effective approach. PATIENTS AND METHODS: A subgroup comprising 705 patients with traumatic cervical SCI from 4 medical centers between January 2015 and December 2020 was retrospectively analyzed. Patients were stratified based on treatment regimen: low-dose MP, high-dose MP, or no MP use. All patients underwent spinal decompression surgery. The degree of neurological recovery and the incidence of complications during follow-up were compared among these 3 groups. In addition, we investigated the disparities in neurological function recovery, neuronal death, and neural axon regeneration between the low-dose and high-dose MP treatment regimens using a SCI rat model. RESULTS: Patients receiving the low-dose MP regimen exhibited superior neurological recovery compared with those receiving the high-dose regimen and those not receiving MP (82.0% vs . 74.0%, P = 0.030; 82.0% vs . 63.4%, P = 0.001). Moreover, patients in the low-dose MP group demonstrated the lowest rates of perioperative pulmonary infections and gastrointestinal bleeding among these 3 groups. Evaluation of the SCI rat model through Basso-Beattie-Bresnahan score, footprint analysis, electrophysiological tests, hematoxylin and eosin staining, immunofluorescence staining, and Nissl staining further corroborated that the low-dose MP treatment regimen enhanced transport function recovery, reduced neuronal death, and promoted neural axon regeneration. CONCLUSION: The low-dose MP regimen may have a more positive therapeutic effect on the recovery of neurological function after SCI than other regimens.