Steroid Therapy in Traumatic Cervical Cord Injury Undergoing Surgery: A Retrospective Seven-Year Study

Abstract

Aims: The present study aimed to investigate the outcome of steroid therapy in patients with traumatic cervical cord injuries undergoing surgery at a single centre. Study Design:  Retrospective cross-sectional study. Place and Duration of Study: Department of spine surgery Hospital Sultan Ismail, Johor between January 2017 to February 2024. Methodology: A total of 76 patients (51 men, 25 women; age range 21-68 years) with cervical spinal cord injury were included. Demographic data, American Spinal Injury Association (ASIA) motor score and injury grade on day 3, 30, 90, 180, and steroid related complications were recorded. Steroid protocol used was Methylprednisolone sodium succinate (MPSS) bolus of 30mg/kg over 1 hour and infusion of 5.4mg/kg for 23 hours if patients presented within 8 hours of injury or intravenous Dexamethasone boluses 8mg 8 hourly for 72 hours if they present after 8 hours. Results: A total 48 patients (63.2%) received steroid therapy, and 28 patients (36.8%) did not receive steroid therapy. Majority of patients presented with ASIA A with 29 (38.2%) followed by ASIA D with 20 patients (26.3%), ASIA B with 18 patients (23.8%) and ASIA C with only 9 patients (11.8%). Distribution of surgery performed had 28 patient receiving anterior surgery (36.8%) and 48 patients receiving posterior surgery (63.2%). There were more complications in the steroid group compared to the non-steroid group (9,3) however it was not statistically significant (P=0.64). Motor grade recovery recorded a progressive gain over the time with the peak gain noted at 6 months injury, there was no statistical difference between the steroid and non-steroid group (P=0.25) with mean grade recovery of +35 ± 14.6 and +30 ± 14.4 respectively. Among the ASIA scale, motor grade recovery at 6 months was the highest in ASIA C with +25 ± 10.1 and +19 ± 8.3 among the steroid and non-steroid group respectively (P=0.42). ASIA scale improvement rates were also the highest in ASIA D and ASIA C with more than 66% improvements with no difference among steroid and non-steroid groups, p-value was not significant in calculation as the size of subgroups were very small. Conclusion: In conclusion, steroid use may be beneficial in traumatic spinal cord injury, however careful patient selection should be observed as steroids are associated with a higher rate of complications. This study is a good pilot project for further future studies looking into steroids and spinal cord injuries.