Methylprednisolone linked to small lower‑limb gains in complete cervical spinal cord injury

A pooled analysis of 908 patients with cervical spinal cord injury found higher lower extremity motor scores at one year with methylprednisolone (MPSS) in AIS grade A (complete) injuries, but no clear motor benefit in AIS grades B–D; overall in‑hospital adverse events were not increased and some categories were reduced in AIS A.

Researchers pooled harmonized data from three large prospective multicenter spinal cord injury studies to assess effects of methylprednisolone (MPSS) in cervical injuries across baseline severity. The combined dataset included 908 patients and enabled subgroup analyses by AIS grade. The analysis found a higher lower extremity motor score (LEMS) at one year among AIS grade A (complete) patients treated with MPSS, while no significant motor benefits were observed in AIS grades B–D (incomplete). Safety analyses reported no overall increase in in‑hospital adverse events with MPSS and noted reduced cardiopulmonary and gastrointestinal/genitourinary events in AIS A patients, though those adverse event analyses were exploratory. Key findings: - MPSS was associated with higher LEMS at one year in AIS grade A (complete) cervical injuries; the observed mean difference was modest and near reported thresholds for minimal clinical importance. - No significant effects of MPSS on upper or lower extremity motor scores were found in AIS grades B, C, or D, and a pooled analysis of B–D showed no benefit. - MPSS use was not linked to an increase in in‑hospital adverse events overall; in AIS A patients, cardiopulmonary and GI/GU events were lower, but these safety results were exploratory and not adjusted for multiple comparisons. Summary: The motor improvement seen in complete cervical injuries was modest and its clinical relevance is uncertain, partly because results were sensitive to how missing data were handled. The authors note limitations including largely non‑randomized MPSS use, incomplete timing and dosing data, and recommend prospective studies with contemporary protocols and detailed dosing/timing information to better evaluate effectiveness and safety.