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Sustained Spinal Cord Compression

Part II: Effect of Methylprednisolone on Regional Blood Flow and Recovery of Somatosensory Evoked Potentials

Investigation performed at Case Western Reserve University, Cleveland, Ohio

Gregory D. Carlson, MD
Orthopaedic Specialty Institute, 280 South Main Street, Suite 200, Orange, CA 92868. E-mail address: gcarlson{at}ocspine.com

Carey D. Gorden, MA
Department of Orthopaedic Surgery and University Hospitals Spine Institute, Case Western Reserve University, Cleveland, OH 44106

Shigenobu Nakazawa, MD
Otonemati 2-84-16, Maebaehishi, Gumma 371-0825, Japan. E-mail address: s-naka@dj8.so-net.ne.jp

Eiji Wada, MD
Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata 573-8511, Japan. E-mail address: hjp42535@mopera.ne.jp

Jeremy S. Smith
Department of Orthopedic Surgery and Reeve-Irvine Research Center, University of California, Irvine, CA 92697

Joseph C. LaManna, PhD
Department of Anatomy and Neurology, Case Western Reserve University, Cleveland, OH 44106. E-mail address: jcl4@po.cwru.edu

In support of their research or preparation of this manuscript, one or more of the authors received an Orthopaedic Research and Education Foundation grant and a Veterans Administration Merit Review Research grant. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression.

Methods: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression.

Results: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone.

Conclusions: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.

Clinical Relevance: This study suggests that a major drawback of methylprednisolone therapy may be the reduction in regional spinal cord blood flow after decompression.

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