The Role of Riluzole in Acute Traumatic Cervical Spinal Cord Injury with Incomplete Neurological Deficit: A Prospective, Randomised Controlled Study

Dinesh Kumarasamy; Vibhu Krishnan Viswanathan; Ajoy Prasad Shetty; Guna K Pratheep; Rishi Mukesh Kanna; S Rajasekaran

doi:10.1007/s43465-022-00758-6

The Role of Riluzole in Acute Traumatic Cervical Spinal Cord Injury with Incomplete Neurological Deficit: A Prospective, Randomised Controlled Study

Indian J Orthop. 2022 Oct 5;56(12):2160-2168. doi: 10.1007/s43465-022-00758-6. eCollection 2022 Dec.

Authors

Dinesh Kumarasamy¹, Vibhu Krishnan Viswanathan¹, Ajoy Prasad Shetty^{1

2}, Guna K Pratheep¹, Rishi Mukesh Kanna¹, S Rajasekaran¹

Affiliations

¹ Department of Spine Surgery, Ganga Medical Centre and Hospital, 313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamil Nadu 641001 India.
² Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital, 313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamil Nadu 641001 India.

Abstract

Introduction: Riluzole, a benzothiazole sodium channel blocker is acknowledged as a neuroprotective agent in spinal cord injury (SCI). Most of this evidence is based on pre-clinical studies and its effectiveness in clinical setting is undetermined, heretofore.

Methods: A prospective, randomised-controlled study was conducted between April 2019 and March 2020 at a tertiary-level centre. Patients aged 18-65 years with sub-axial cervical spine injury, who presented within 72 h of injury with incomplete neuro-deficit, were included. They were randomised into groups A (riluzole was administered) and B (no adjuvants). All patients were followed up at 6 weeks/3/6/12 months, and clinical [ASIA motor/sensory scores/grade, SCIM3, and NRS (neuropathic pain)] and radiological evaluation was performed.

Results: Twenty-three and 20 patients were included in groups A and B. Two in group A were females, while others were males (p = 0.49). Mean age in groups A and B was 47.7 ± 14.8 and 51.2 ± 14.1 years (p = 0.44). Five patients died prior to 6th-week follow-up. Among the others, there was significant improvement in all neurological parameters in both groups (post-injury vs 1-year; motor score: p < 0.001, sensory score: p < 0.001, SCIM3: p < 0.001, NRS: p < 0.001). In both groups, initial significant improvement was noticed even at the 6th-week follow-up, which further continued until the end of 1 year. There was no statistically significant difference between groups A and B with respect to these neurological parameters (motor: p = 0.15, sensory: p = 0.39, SCIM3: p = 0.68, NRS: p = 0.06).

Conclusion: Administration of riluzole did not significantly improve neurological outcome/neuropathic pain in our cohort. Nevertheless, both our groups demonstrated an overall improvement in neurological outcome at 1 year, as compared with immediate post-injury status.

Keywords: Benzothiazole molecule; Neurological deficit; Neurological outcome; Riluzole; Traumatic cervical spine injury.

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