title: 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: Department of Neurosurgery and Spinal Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Mohamad
authors: M
authors: Bydon
authors: Department of Neurosurgery and Spinal Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Joseph
authors: J
authors: Lin
authors: Department of Neurosurgery and Spinal Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Mohamed
authors: M
authors: Macki
authors: Department of Neurosurgery and Spinal Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Ziya L
authors: ZL
authors: Gokaslan
authors: Department of Neurosurgery and Spinal Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA. Electronic address: abydon1@jhmi.edu.
authors: Ali
authors: A
authors: Bydon
mesh_terms: D000208:Acute Disease; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: ASCI; ASIA classification system; Acute spinal cord injury; Methylprednisolone; Steroids