Minocycline in Acute Traumatic Spinal Cord Injury: A Systematic Review and Exploratory Meta Analysis of Preclinical and Clinical Evidence

Introduction: Minocycline as a tetracycline derivative agent with anti-inflammatory and neuroprotective properties, has been investigated in both experimental and clinical settings. This study aimed to evaluated the therapeutic efficacy of Minocycline in acute traumatic spinal cord injury (SCI). Methods: This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Major electronic databases were comprehensively searched to identify preclinical animal studies and human clinical studies evaluating minocycline, alone or in combination therapies, for acute traumatic SCI management. Risk of bias was assessed using Joanna Briggs Institute (JBI) critical appraisal tools tailored to study design. Qualitative synthesis included all eligible studies, while quantitative synthesis was restricted to clinical studies reporting extractable effect estimates for neurological improvement. Results: A total of 9 studies met inclusion criteria for qualitative synthesis. Preclinical studies demonstrated consistent biological effects of minocycline on inflammatory markers, oxidative stress, and histopathological outcomes, particularly in combination therapies, although functional recovery with minocycline monotherapy was inconsistent. Clinical studies indicated that minocycline was generally well tolerated; however, most trials did not demonstrate statistically significant improvements in neurological or functional outcomes. Only two clinical studies provided suitable data for meta-analysis, yielding a pooled odds ratio of 1.70 (95% confidence interval (CI): 0.95–3.06) for neurological improvement, which did not reach statistical significance. Conclusion: Current evidence suggests that while minocycline exhibits promising biological activity and an acceptable safety profile in acute traumatic SCI, robust clinical efficacy has not been conclusively demonstrated. Well-designed, adequately powered randomized controlled trials with standardized outcome reporting are required to determine whether these biological effects translate into meaningful functional recovery.