Granulocyte-Colony Stimulating Factor Improves Neurologic and Functional Outcomes in Patients with Traumatic Incomplete Spinal Cord Injuries: A Systematic Review with Meta-Analyses

Introduction: Traumatic spinal cord injury (SCI) is a cause for significant morbidity, often resulting in long-term disability. We aimed to compare outcomes after administration of granulocyte-colony stimulating factor (G-CSF) versus patients who received placebo, supportive cares with no specific intervention, or methylprednisolone (MP).

Methods: MEDLINE, Embase, and Cochrane Library database searches yielded 222 records, 6 met study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each primary outcome.

Results: The results of the pooled analysis showed that in patients with incomplete traumatic SCI, G-CSF resulted in increased ASIA motor scores at 3 months (MD 0.57 [95% CI 0.04,1.10]; I2 = 63.84%; P = 0.036), 6 months (MD 4.18 [95% CI 0.55,7.80]; I2 = 98.75%; P = 0.024), change in ASIA pinprick scores at 6 months (MD 3.38 [95% CI 1.48,5.28]; I2 = 89.78%; P < 0.001), and increased SCIM III score at 6 months (MD 3.27 [95% CI 1.13,5.41]; I2 = 91.86%; P = 0.003). G-CSF resulted in more adverse events than the non-MP control groups (OR 1.44 [95% CI 0.38,2.50]; I2 = 0%; P = 0.008), but fewer than the MP control groups (OR -4.2 [95% CI -5.72,-2.68]; I2 = 0%; P < 0.001). Systemic WBC count increased following administration of G-CSF in comparison to baseline (MD 3.57 [95% CI 2.79,4.35]; I2 = 55.06%; P < 0.001). G-CSF did not statistically increase AIS at 3 months (MD 0.48 [95% CI -0.33,1.28]; I2 = 0%; P = 0.246) or at 6 months (MD 1.84 [95% CI -0.10,3.79]; I2 = 50.09%; P = 0.063).

Conclusion : These meta-analyses suggest that G-CSF for the treatment of incomplete traumatic SCI results in improved neurologic outcomes when compared to the controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of G-CSF for traumatic SCI.