Michael G. Fehlings, Toronto Western Hospital; University of TorontoFollow
Jefferson R. Wilson, University of Toronto; St. Michael’s HospitalFollow
Lindsay A. Tetreault, Toronto Western Hospital; University College CorkFollow
Bizhan Aarabi, University of MarylandFollow
Paul A. Anderson, University of Wisconsin, MadisonFollow
Paul M. Arnold, The University of KansasFollow
Darrel S. Brodke, University of UtahFollow
Anthony S. Burns, Toronto Rehabilitation InstituteFollow
Kazuhiro Chiba, National Defense Medical College
Joseph R. Dettori, Spectrum Research, Inc
Julio C. Furlan, University of Toronto; Toronto Rehabilitation InstituteFollow
Gregory W. Hawryluk, University of Utah
Langston T. Holly, University of California, Los AngelesFollow
Susan Howley, Christopher & Dana Reeve Foundation
Tara Jeji, Ontario Neurotrauma Foundation
Sukhvinder Kalsi-Ryan, Toronto Western HospitalFollow
Mark R. Kotter, University of Cambridge
Shekar N. Kurpad, Medical College of WisconsinFollow
Brian Kwon, University of British ColumbiaFollow
Ralph J. Marino, Thomas Jefferson UniversityFollow
Allan R. Martin, Toronto Western HospitalFollow
Eric M. Massicotte, Toronto Western HospitalFollow
Geno J. Merli, Thomas Jefferson UniversityFollow
James W. Middleton, University of SydneyFollow
Hiroaki Nakashima, Nagoya UniversityFollow
Narihito Nagoshi, Toronto Western Hospital; Keio UniversityFollow
Katherine Palmieri, The University of KansasFollow
Andrea C. Skelly, Spectrum Research, Inc
Anoushka Singh, Toronto Western HospitalFollow
Eve Tsai, Ottawa Hospital Research InstituteFollow
Alexander R. Vaccaro, Thomas Jefferson UniversityFollow
Albert Yee, Sunnybrook Health Sciences CentreFollow
James S. Harrop, Thomas Jefferson UniversityFollow

Document Type


Publication Date



This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 3 Supplement, September 2017, Pages 203S-211S.

The published version is available at DOI: 10.1177/2192568217703085. Copyright © Fehlings et al.


Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”; (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients. © 2017, © The Author(s) 2017.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.