The role of steroids in acute spinal cord injury: an evidence-based analysis.
METHODS
Literature review.


OBJECTIVE
The purpose of this article is to review the available literature and formulate evidence-based recommendations for the use of methylprednisone in the setting of acute spinal cord injury (SCI).


BACKGROUND
Since the early 1990s, methylprednisolone has become widely prescribed for the treatment of acute SCI. Arguably, it has become a standard of care.


METHODS
Through an electronic database search strategy and by cross-reference with published literature, appropriate clinical studies were identified. They were reviewed in chronologic order with respect to study design, outcome measures, results, and conclusions.


RESULTS
Nine studies were identified that attempted to evaluate the role of steroids in nonpenetrating (blunt) spinal cord injury. Five of these were Class I clinical trials, and four were Class II studies. All of the studies failed to demonstrate improvement because of steroid administration in any of the a priori hypotheses testing. Although post hoc analyses were interesting, they failed to demonstrate consistent significant treatment effects.


CONCLUSIONS
From an evidence-based approach, methylprednisolone cannot be recommended for routine use in acute nonpenetrating SCI. Prolonged administration of high-dose steroids (48 hours) may be harmful to the patient. Until more evidence is forthcoming, methylprednisolone should be considered to have investigational (unproven) status only.
Hurlbert
R J
RJ
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada. jhurlber@ucalgary.ca
D000208:Acute Disease; D019317:Evidence-Based Medicine; D006801:Humans; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000188:drug therapy*; D014949:Wounds, Nonpenetrating / Q000188:drug therapy*
D018696:Neuroprotective Agents; D008775:Methylprednisolone