• Yu Zhang, Shining Xiao, Liangbo Zhu, Xinrong Gan, Yongquan Huang, Fan Dan, Jiangwei Chen, Rongping Zhou, Wen Tang, Jiaming Liu, and Zhili Liu.
• Department of Orthopedics, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China.
• Spine. 2025 Jan 29.

Study DesignSubgroup analysis of a retrospective clinical and animal trial [Study of different doses of methylprednisolone on functional recovery of spinal cord injury].ObjectiveThe aimed to investigate the efficacy of low-dose methylprednisolone regimens in promoting neural repair after SCI.Summary Of Background DataSpinal cord injury (SCI) can result in sensory, motor, and autonomic nerve dysfunction, often leading to disability or death. Methylprednisolone (MP) is a preferred medication for clinical treatment of SCI. Low-dose regimen may be a safer and more effective approach.MethodsA subgroup comprising 705 patients with traumatic cervical SCI from four medical centers between January 2015 and December 2020 was retrospectively analyzed. Patients were stratified based on treatment regimen: low-dose methylprednisolone, high-dose methylprednisolone, or no methylprednisolone use. All patients underwent spinal decompression surgery. The degree of neurological recovery and the incidence of complications during follow-up were compared among these three groups. Additionally, we investigated the disparities in neurological function recovery, neuronal death, and neural axon regeneration between the low-dose and high-dose methylprednisolone treatment regimens using a SCI rat model.ResultsPatients receiving the low-dose methylprednisolone regimen exhibited superior neurological recovery compared to those receiving the high-dose regimen and those not receiving methylprednisolone (82.0% vs. 74.0%, P=0.030; 82.0% vs. 63.4%, P=0.001). Moreover, patients in the low-dose methylprednisolone group demonstrated the lowest rates of perioperative pulmonary infections and gastrointestinal bleeding among these three groups. Evaluation of the SCI rat model through Basso-Beattie-Bresnahan (BBB) score, footprint analysis, electrophysiological tests, hematoxylin and eosin (H&E) staining, immunofluorescence staining, and Nissl staining further corroborated that the low-dose methylprednisolone treatment regimen enhanced transport function recovery, reduced neuronal death, and promoted neural axon regeneration.ConclusionThe low-dose methylprednisolone regimen may have a more positive therapeutic effect on the recovery of neurological function after SCI than other regimens.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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