Steroid use in Spinal Cord Injury

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13 Jul 2016 - General

The use of steroids for acute spinal cord injury has always been controversial. In 1980’s, when NASCIS I trial was published, methylprednisolone became an off-label therapy for acute spinal cord injury. Results of the trial failed to demonstrate any benefit in terms of functional recovery and complications were also documented. In the 1990’s, NASCIS II trial was published with conflicting results with the first trial. Results showed neurologic benefits, making methylprednisolone a standard treatment in acute SCI. In NASCIS III, methylprednisolone was found to be more beneficial, if infused within 3-8 hrs post-injury and prolonged administration had increased incidence of severe infections. However, there were concerns regarding the results of the NASCIS II and III trials such as underreporting of complications and post-hoc methodology in determining functional recovery. The latest published guideline in 2013, with level I recommendation states that administration of methylprednisolone for treatment of acute SCI is NOT recommended. Despite this, there has been varied practice among healthcare professionals in treating of acute SCI with steroid therapy. Personally in our institution, there are some specialists who administer methylprednisolone within 24-48 hrs post injury and others prefer to use dexamethasone over methylprednisolone. What is your experience on this and have you experienced any severe complication attributable to the use of MP/dexa in acute SCI?