Methylprednisolone in spinal trauma: a Sistematic Review

Abstract

Introduction. Methylprednisolone is a pharmacological treatment for acute traumatic spinal cord injuries, the use of which remains controversial. Objective. To describe the evidence of the use of methylprednisolone in patients with spinal trauma. Method. This is a systematic review of the literature. Randomized clinical studies of patients who received methylprednisolone in the intervention arm, compared with placebo or another drug, were investigated in the Lilacs and Medline databases, compared to placebo or another drug, starting treatment within 48 hours of the trauma diagnosis. There was no language restriction or publication date. The primary outcomes assessed were mortality, motor function, superficial and / or deep sensitivity, while the secondary outcomes were adverse effects, quality of life and functional independence. The studies were assessed for bias by the Jadad score, while the evidence was classified according to the levels of the University of Oxford. The results were summarized qualitatively. Results. Five publications were included in the analysis, all at level one of evidence for treatment benefit studies, with 1092 randomized patients. 40% of the studies achieved good quality scores, with the masking and description of the segment losses being the ones that caused the most score downgrades. Conclusion. Ee do not recommend the use of methylprednisolone, due to the lack of significant improvement in motor function and sensitivity, in addition to not reducing mortality. Functional independence also did not improve, while quality of life was not even assessed in the included studies. The use of the drug was also associated with increased adverse effects.