What are the guidelines on steroid therapy in the treatment of spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS, FAANS; Chief Editor: Brian H Kopell, MD  more...
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As a result of the controversy over the NACSIS II and III studies, a number of professional organizations have revised their recommendations pertaining to steroid therapy in SCI. [46, 47]

The Congress of Neurological Surgeons (CNS) has stated that steroid therapy "should only be undertaken with the knowledge that the evidence suggesting harmful side effects is more consistent than any suggestion of clinical benefit." [48] The American College of Surgeons (ACS) has modified their advanced trauma life support (ACLS) guidelines to state that methylprednisolone is "a recommended treatment" rather than "the recommended treatment." The Canadian Association of Emergency Physicians (CAEP) is no longer recommending high-dose methylprednisolone as the standard of care.

In a survey conducted by Eck and colleagues, 90.5% of spine surgeons surveyed used steroids in SCI, but only 24% believed that they were of any clinical benefit. [49] Note that the investigators not only discovered that approximately 7% of spine surgeons do not recommend or use steroids at all in acute SCI, but that most centers were following the NASCIS II trial protocol.

Updated guidelines issued in 2013 by the CNS and the American Association of Neurological Surgeons (AANS) recommend against the use of steroids early after an acute SCI. The guidelines recommend that methylprednisolone not be used for the treatment of acute SCI within the first 24-48 hours following injury. The previous standard was revised because of a lack of medical evidence supporting the benefits of steroids in clinical settings and evidence that high-dose steroids are associated with harmful adverse effects. [50, 51]

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