The Effect of High dose Methylprednisolone Administration on Clinical Outcome and Complication of Surgical Treatment of Cervical Spondylotic Myelopathy

Karimi Yarandi, K; Amirjamshidi, A; Mortazavi, A; Alimohamadi, M; Ghadirian, H; Najafi, S

The Effect of High dose Methylprednisolone Administration on Clinical Outcome and Complication of Surgical Treatment of Cervical Spondylotic Myelopathy

Document Type : Original Article

Authors

K Karimi Yarandi ¹

A Amirjamshidi ²

A Mortazavi ¹

M Alimohamadi ¹

H Ghadirian ¹

S Najafi ¹

¹ Assistant Professor, Department of Neurosurgery, Tehran University of Medical Sciences, Sina Hospital

² Professor of Neurosurgery, Tehran University of Medical Sciences and Health Services, Sina Hospital, Tehran, Iran

Abstract

Introduction & Objective: One of the proper methods to reduce the complications of spine surgeries and to accelerate the patient's recovery process is to use methylprednisolone before, during or after surgery. The aim of this study was to investigate the effect of prophylactic administration and high dose methylprednisolone on the prognosis of surgical intervention in patients with cervical myelopathy. Materials & Methods: The study was a randomized controlled clinical trial in patients with cervical myelopathy. Patients with myelopathy who had a surgical indication were included in the study due to spondylosis, degeneration of the cervical intervertebral disks, osteophytes, calcification of the posterior longitudinal ligament, thickening of the ligamentum of flavum, hypertrophic osteoarthritis and other non-traumatic pathologies. In one group, methylprednisolone was injected at high dosages of 12.5 mg/kg intravenous infusion within 30 minutes, and then (after half an hour) at a dose of 1 mg/kg/hr in the form of continuous intravenous infusion (to the end of surgery). In the other group, this injection was not performed. Before and after surgery (four times: 48 hours, two weeks, one month and six months later), the patients were examined by the team and scored in terms of Japanese Orthopedic Association Score (JOA) and Modified Rankin Scale (MRS). The efficacy of high doses of methylprednisolone was compared by comparing the patients' score before and after surgery in two groups. Results: 72 patients participated in this study. 34 patients were injected with methylprednisolone and 38 patients remained in the control group. There was no significant difference between JOA and MRS scores before and at different postoperative times between the two groups. Post-surgical complications were not significantly different between the two groups. Conclusions: There was no significant difference between two groups in terms of intraoperative variables such as bleeding and surgical time, as well as post-operative complications such as surgery site infections and deep vein thrombosis. Finally, according to the findings of the study, it can be argued that the administration of methylprednisolone during surgery cannot contribute to the improvement of neurological function.

Keywords

Methylprednisolone

Cervical Myelopathy

JOA Score

Modified Rankin Scale

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