Abstract
Background: High-dose steroid injection therapy is effective in reducing anti-inflammation and edema and is often used to treat patients with acute spinal cord injury. To evaluate the effectiveness of steroid pulse therapy and identify the factors that affect its effectiveness in patients with acute traumatic spinal cord injury. Methods: A comprehensive literature search of the databases Pubmed, Medline, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL was performed on July 31, 2019, with no language and time limits. For analysis, studies conducted within the last 10 years were included to reflect on the recent trend. Results: A total of 3 randomized controlled trials and 5 observational studies with 2418 patients were included in this meta-analysis. High-dose steroid injection therapy was found to have a high effect on patients with acute spinal cord injury. The following factors had a strong influence on the effectiveness of high-dose steroid treatment in patients with acute spinal cord injuries: injury, onset ASIA, onset neurological assessment scales, time to start treatment after injury, age, BMI, and gender. Conclusion: It is necessary to accurately assess the scope of spinal injury in the early stages and actively provide nursing interventions to identify and mediate factors affecting the treatment effect.
Highlights
The spinal cord is a central nerve in the spine that can suffer damage due to accidents, diseases, or any injury to the spine [1, 2]
A spinal cord injury is mainly caused by trauma such as a car accident or crash, which results in loss of movement due to paralysis of the motor nerves below the level of injury, loss of sensation, and abnormality in bladder and bowel movement controlled by the autonomic nervous system [4, 5]
This study was conducted through meta-analysis to identify the effectiveness and associated factors of high-dose steroid infusion applied to patients with acute spinal injury
Summary
The spinal cord is a central nerve in the spine that can suffer damage due to accidents, diseases, or any injury to the spine [1, 2]. High-dose steroid injection therapy is effective in reducing anti-inflammation and edema and is often used to treat patients with acute spinal cord injury. During the first 4-8 hours after spinal cord injury, partial tissue necrosis begins to appear in the impacted area, and within 24-48 hours, tissue necrosis becomes apparent and progresses extensively to the adjacent spinal cord segments that have been impacted. This change reaches its peak at 24 h, following which there are minimal changes in the 24 h [3, 8]. The guidelines for steroid medication instruct to first inject methylprednisolone (30 mg per kilogram of weight) into the vein for 15 min, followed by 45 minutes of rest, and injecting 5.4 mg per kilogram of weight per hour over 23 hours for 3-5 days [15 - 17]
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