Volume 2, Issue 1 (6-2016)                   Iran J Neurosurg 2016, 2(1): 11-14 | Back to browse issues page


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Yousefzadeh-Chabok S, Alijani B, Emamhadi M, Behzadnia H, Dehghani S, Razzaghi A et al . A Comparison between Therapeutic Effect of Granulocyte Colony-stimulating Factor and Methylprednisolone in Treatment of Patients with Acute Traumatic Spinal Cord Injury. Iran J Neurosurg 2016; 2 (1) :11-14
URL: http://irjns.org/article-1-31-en.html
1- MD, Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
2- MD, Associate Professor of Neurosurgery,Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran , babakalij@gmail.com
3- MD, Associate Professor of Neurosurgery,Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
4- MD, Assistant Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
5- MD, Senior Resident of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
6- MSc in Epidemiology, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Abstract:   (6141 Views)

Background & Aim: Spinal cord injury (SCI) is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities. 

Methods & Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 hours of injury to compare granulocyte colony stimulating factor (G-CSF) and high-dose methylprednisolone as neuroprotective therapy.

Results: In this research, 122 patients were studied out of whom 62 patients were included in the granulociote colony-stimulating factor (G-CSF) group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 out of 122 patients (45%) were completely paralyzed (Grade AIS:A) and 67 (55%) were with incomplete spinal injury (Grade AIS:B,C,D). The average American spinal injury association (ASIA) sensory scores in the two groups were similarly compared in the same four time intervals, and p values were 0.7, 0.3, 0.2, and 0.1. They were not statistically significant. 

Conclusion: According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment (p value=0.04), and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment (p value=0.03). A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are needed. 

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Type of Study: Research | Subject: Gamma Knife Radiosurgery

References
1. Thuret S, Moon LD, Gage FH. Therapeutic interventions after spinal cord injury. Nature reviews Neuroscience. 2006;7(8):628-43. [DOI:10.1038/nrn1955] [PMID]
2. Weaver FM, Hammond MC, Guihan M, Hendricks RD. Department of Veterans Affairs Quality Enhancement Research Initiative for spinal cord injury. Medical care. 2000;38(6 Suppl 1):I82-91. [DOI:10.1097/00005650-200006001-00009]
3. Rowland JW, Hawryluk GW, Kwon B, Fehlings MG. Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon. Neurosurgical Focus. 2008;25(5):E2. [DOI:10.3171/FOC.2008.25.11.E2] [PMID]
4. Mueller CA, Schluesener HJ, Conrad S, Pietsch T, Schwab JM. Spinal cord injury-induced expression of the immune-regulatory chemokine interleukin-16 caused by activated microglia/macrophages and CD8+ cells. Journal of Neurosurgery Spine. 2006;4(3):233-40. [DOI:10.3171/spi.2006.4.3.233] [PMID]
5. Ek CJ, Habgood MD, Dennis R, Dziegielewska KM, Mallard C, Wheaton B, et al. Pathological changes in the white matter after spinal contusion injury in the rat. PloS one. 2012;7(8):e43484. [DOI:10.1371/journal.pone.0043484] [PMID] [PMCID]
6. Norenberg MD, Smith J, Marcillo A. The pathology of human spinal cord injury: defining the problems. Journal of Neurotrauma. 2004;21(4):429-40. [DOI:10.1089/089771504323004575] [PMID]
7. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, 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. The New England Journal of Medicine. 1990;322(20):1405-11. [DOI:10.1056/NEJM199005173222001] [PMID]
8. Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. Jama. 1997;277(20):1597-604. https://doi.org/10.1001/jama.277.20.1597 [DOI:10.1001/jama.1997.03540440031029] [PMID]
9. Hugenholtz H, Cass DE, Dvorak MF, Fewer DH, Fox RJ, Izukawa DM, et al. High-dose methylprednisolone for acute closed spinal cord injury--only a treatment option. The Canadian journal of neurological sciences Le Journal Canadien des Sciences Neurologiques. 2002;29(3):227-35. [DOI:10.1017/S0317167100001992] [PMID]
10. Hurlbert RJ. The role of steroids in acute spinal cord injury: an evidence-based analysis. Spine. 2001;26(24 Suppl):S39-46. [DOI:10.1097/00007632-200112151-00009] [PMID]
11. Ito Y, Sugimoto Y, Tomioka M, Kai N, Tanaka M. Does high dose methylprednisolone sodium succinate really improve neurological status in patient with acute cervical cord injury?: a prospective study about neurological recovery and early complications. Spine. 2009;34(20):2121-4. [DOI:10.1097/BRS.0b013e3181b613c7] [PMID]
12. 12. Matsumoto T, Tamaki T, Kawakami M, Yoshida M, Ando M, Yamada H. Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury. Spine. 2001;26(4):426-30. [DOI:10.1097/00007632-200102150-00020]
13. Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine. 2003;28(1):33-9. [DOI:10.1097/00007632-200301010-00009]
14. Rabchevsky AG, Fugaccia I, Sullivan PG, Blades DA, Scheff SW. Efficacy of methylprednisolone therapy for the injured rat spinal cord. Journal of Neuroscience Research. 2002;68(1):7-18. [DOI:10.1002/jnr.10187] [PMID]
15. Boneberg EM, Hartung T. Molecular aspects of anti-inflammatory action of G-CSF. Inflammation research : official journal of the European Histamine Research Society [et al]. 2002;51(3):119-28. [DOI:10.1007/PL00000283]
16. Ha Y, Kim YS, Cho JM, Yoon SH, Park SR, Yoon DH, et al. Role of granulocyte-macrophage colony-stimulating factor in preventing apoptosis and improving functional outcome in experimental spinal cord contusion injury. Journal of Neurosurgery Spine. 2005;2(1):55-61. [DOI:10.3171/spi.2005.2.1.0055] [PMID]
17. Huang HY, Lin SZ, Kuo JS, Chen WF, Wang MJ. G-CSF protects dopaminergic neurons from 6-OHDA-induced toxicity via the ERK pathway. Neurobiology of Aging. 2007;28(8):1258-69. [DOI:10.1016/j.neurobiolaging.2006.05.037] [PMID]
18. Chen WF, Jean YH, Sung CS, Wu GJ, Huang SY, Ho JT, et al. Intrathecally injected granulocyte colony-stimulating factor produced neuroprotective effects in spinal cord ischemia via the mitogen-activated protein kinase and Akt pathways. Neuroscience. 2008;153(1):31-43. [DOI:10.1016/j.neuroscience.2008.01.062] [PMID]
19. Lu CZ, Xiao BG. Neuroprotection of G-CSF in cerebral ischemia. Frontiers in Bioscience: a Journal and Virtual Library. 2007;12:2869-75. [DOI:10.2741/2278]
20. Sehara Y, Hayashi T, Deguchi K, Zhang H, Tsuchiya A, Yamashita T, et al. Decreased focal inflammatory response by G-CSF may improve stroke outcome after transient middle cerebral artery occlusion in rats. Journal of Neuroscience Research. 2007;85(10):2167-74. [DOI:10.1002/jnr.21341] [PMID]
21. Schneider A, Kruger C, Steigleder T, Weber D, Pitzer C, Laage R, et al. The hematopoietic factor G-CSF is a neuronal ligand that counteracts programmed cell death and drives neurogenesis. The Journal of Clinical Investigation. 2005;115(8):2083-98. [DOI:10.1172/JCI23559] [PMID] [PMCID]
22. Schabitz WR, Kollmar R, Schwaninger M, Juettler E, Bardutzky J, Scholzke MN, et al. Neuroprotective effect of granulocyte colony-stimulating factor after focal cerebral ischemia. Stroke; a Journal of Cerebral Circulation. 2003;34(3):745-51. [DOI:10.1161/01.STR.0000057814.70180.17] [PMID]
23. Takahashi H, Yamazaki M, Okawa A, Sakuma T, Kato K, Hashimoto M, et al. Neuroprotective therapy using granulocyte colony-stimulating factor for acute spinal cord injury: a phase I/IIa clinical trial. European Spine Journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012;21(12):2580-7. [DOI:10.1007/s00586-012-2213-3] [PMID] [PMCID]
24. Derakhshanrad N, Saberi H, Yekaninejad MS, Eskandari G, Mardani A, Rahdari F, et al. Safety of granulocyte colony-stimulating factor (G-CSF) administration for postrehabilitated motor complete spinal cord injury patients: an open-label, phase I study. Cell Transplantation. 2013;221:S139-46. [DOI:10.3727/096368913X672109] [PMID]
25. Kamiya K, Koda M, Furuya T, Kato K, Takahashi H, Sakuma T, et al. Neuroprotective therapy with granulocyte colony-stimulating factor in acute spinal cord injury: a comparison with high-dose methylprednisolone as a historical control. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2015;24(5):963-7. [DOI:10.1007/s00586-014-3373-0] [PMID]
26. Inada T, Takahashi H, Yamazaki M, Okawa A, Sakuma T, Kato K, et al. Multicenter prospective nonrandomized controlled clinical trial to prove neurotherapeutic effects of granulocyte colony-stimulating factor for acute spinal cord injury: analyses of follow-up cases after at least 1 year. Spine. 2014;39(3):213-9. [DOI:10.1097/BRS.0000000000000121] [PMID]

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