Pharmaceutical treatment of spinal cord injuries in the acute phase

Abstract

The initial treatment of spinal cord injuries during the acute phase is very important as it largely determines the prognosis of patients. The purpose of this study is to review the medical interventions in the acute phase after spinal cord injury. In the PUBMED database, a search was performed with the following keywords: (“methylprednisolone” OR “riluzole” OR “rho inhibitor” OR “cethrin” OR “G-CSF” OR “minocycline” OR “TRH” OR “GM-1”) AND “spinal cord injury”. Only prospective, randomized, placebo-controlled studies written in English were included in the study. Studies published in non-English language, incident reports, retrospective studies, observational studies, systematic reviews, experimental animal studies were excluded from the review. Finally, 17 studies were included in the present review, including the following drugs: methylprednisolone (8 studies), rizulole (1 study), G-CSF (1 study), rho inhibitors (2 studies), minocycline (1 study), TRH (1 study), ganglioside GM-1 (2 studies), combination of progesterone and vitamin D (1 study). There is currently no drug with a high level of evidence that can be administered against acute spinal cord injuries. There is not enough convincing evidence that high doses of methylprednisolone for acute spinal cord injury are beneficial, given the high rate of complications. The role of steroids in acute spinal cord injury remains unclear, and some studies have shown that the risks of steroids outweigh the benefits. With many promising therapeutic agents and strategies being studied in ongoing trials for spinal cord injury, there is great hope of finding an effective treatment that would make significant progress while also benefiting patients with other neurological conditions.