The current role of steroids in acute spinal cord injury.

Abstract

BACKGROUND:

Acute spinal cord injury (ASCI) is a catastrophic event that can profoundly affect the trajectory of a patient's life. Debate continues over the pharmacologic management of ASCI, specifically, the widespread but controversial use of the steroid methylprednisolone (MP). Treatment efforts are impeded because of limitations in understanding of the pathobiology of ASCI and the difficulty in proving the efficacy of therapies.

METHODS:

This review presents the pathophysiology of ASCI and the laboratory and clinical findings on the use of MP.

RESULTS:

The use of MP remains a contentious issue in part because of the catastrophic nature of ASCI, the paucity of treatment options, and the legal ramifications. Although historical data on the use of MP in ASCI have been challenged, more recent studies have been used both to support and to oppose treatment of ASCI with steroids.

CONCLUSIONS:

ASCI is a devastating event with a complex aftermath of secondary damaging processes that worsen the initial injury. Although the results of NASCIS (National Acute Spinal Cord Injury Study) II and III trials led to the widespread adoption of a high-dose MP regimen for patients treated within 8 hours of injury, subsequent studies have called into question the validity of NASCIS conclusions. Further evidence of the ineffectiveness of the MP protocol has led to declining confidence in the treatment over the last decade. At the present time, high-dose MP cannot be recommended as a standard of care, but it remains an option until supplanted by future evidence-based therapies.

• Authors: Mohamad Bydon, Joseph Lin, Mohamed Macki, Ziya L Gokaslan, Ali Bydon
• Journal: World neurosurgery (World Neurosurg) Vol. 82 Issue 5 Pg. 848-54 (Nov 2014) ISSN: 1878-8769 [Electronic] United States
• PMID: 23454689 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Glucocorticoids
• Methylprednisolone

Topics

• Acute Disease
• Glucocorticoids (therapeutic use)
• Humans
• Methylprednisolone (therapeutic use)
• Spinal Cord Injuries (complications, drug therapy, physiopathology)