A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury

Abstract

After reading the recent article by Bracken et al. (May 17 issue),¹ we have several questions regarding data not discussed that would facilitate our analysis of this very important work. First, we understand from the description of the neurologic examination that proprioceptive function was not recorded and that in patients with a "complete" injury, proprioception may have been intact. A recent study suggests that the presence or absence of proprioception is strongly predictive of neurologic outcome in patients with acute spinal-cord injury.² Bracken et al.³ reported previously that a complete sensory examination (including tests of proprioception) was necessary to predict a patient's response to clinical intervention, and that motor improvement was more probable when good sensory function was present on admission. For example, we recently treated three patients presenting with flaccid quadriplegia and only proprioceptive function who made substantial improvements after surgical intervention.