Methylprednisolone regimens for management of cauda equina syndrome widely vary in dose and duration, and are primarily derived from case reports (see Tables 1-4). Treatment strategies mainly consist of intravenous administration, ranging from 250 mg to 1 g daily, with adjunct pharmacotherapy (e.g., oral prednisone, intrathecal methylprednisolone) provided, thus limiting consensus on the most optimal dosing for this patient population.
Clinical trials evaluating the use of methylprednisolone in the management of spinal cord injuries have studied various dosage regimens. One of the first clinical trials, the National Acute Spinal Cord Injury Study (NASCIS 1, published in 1984), compared methylprednisolone given as a 100 mg bolus followed by 25 mg every 6 hours for 10 days versus 1,000 mg bolus followed by 250 mg every 6 hours for 10 days. No difference in observed improvements occurred between the high- and low-dose groups, but there was a significantly increased incidence of wound infections in the high-dose group (9.3% vs. 2.6%) as well as a slightly higher incidence of sepsis, pulmonary embolism, and death within 14 days. In the subsequent trial (NASCIS II, published in 1990), patients received methylprednisolone as a 30 mg/kg bolus followed by 5.4 mg/kg for 23 hours, which was found to produce similar effects on motor and sensory scores compared to naloxone 5.4 mg/kg bolus followed by 0.5 mg/kg/h for 23 hours a...
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A search of the published medical literature revealed
4 studies investigating the researchable question:
Are there recommendations for IV or PO methylprednisolone dosing for cauda equina syndrome?
Level of evidence
D - Case reports or unreliable data
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[1] Cheung V, Hoshide R, Bansal V, Kasper E, Chen CC. Methylprednisolone in the management of spinal cord injuries: Lessons from randomized, controlled trials. Surg Neurol Int. 2015;6:142. Published 2015 Aug 24. doi:10.4103/2152-7806.163452
[2] Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251(1):45-52.
[3] Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N...