Skip to main content

Steroids in Spinal Cord Injury

 The use of steroids, particularly high-dose methylprednisolone (MP), in the treatment of acute spinal cord injury (SCI) has been extensively studied and remains a topic of debate. The primary goal of administering steroids post-injury is to mitigate secondary damage by reducing inflammation and oxidative stress. However, the efficacy and safety of this approach have been questioned.



Key Clinical Trials and Findings:

  1. National Acute Spinal Cord Injury Study (NASCIS) II (1990): This randomized controlled trial evaluated the effects of high-dose MP administered within 8 hours of injury. A subgroup analysis suggested a modest improvement in motor function scores for patients treated within this time frame. However, the clinical significance of this improvement has been debated, and concerns about methodological limitations were raised.

    TheNNT

  2. NASCIS III (1997): This study compared 24-hour and 48-hour MP infusion protocols. The results did not demonstrate a significant benefit in neurological outcomes with extended MP administration. Additionally, there was an observed increase in severe pneumonia cases in the 48-hour MP group, raising concerns about potential harms associated with prolonged steroid use.

    TheNNT

  3. Cochrane Review (2012): An updated systematic review concluded that high-dose MP administered within 8 hours of acute SCI resulted in a small improvement in motor function. However, the review also highlighted the lack of significant long-term benefits and the increased risk of complications, leading to a recommendation against the routine use of MP in acute SCI.

    Welcome

  4. TheNNT.com Analysis: A review of multiple trials indicated no clear benefit of steroid use in acute SCI and noted an increased incidence of complications such as infections and gastrointestinal issues. The analysis concluded that the potential harms of high-dose MP likely outweigh any benefits, advising against its routine use.

    TheNNT

Current Clinical Recommendations:

Based on the available evidence, several professional organizations, including the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, recommend against the routine use of high-dose MP in the treatment of acute SCI due to the lack of definitive benefit and the potential for significant adverse effects.

TheNNT

Conclusion:

While early studies suggested a potential role for high-dose steroids in improving outcomes following acute spinal cord injury, subsequent analyses and reviews have not demonstrated consistent or clinically significant benefits. Moreover, the increased risk of serious complications associated with steroid use has led to a consensus against their routine administration in this context. Clinicians are advised to consider alternative therapeutic strategies and to focus on supportive care measures that have a more established efficacy and safety profile.

The latest ATLS 10th edition Guidelines say there is insufficient data to recommend for or against the usage of steroids in acute spinal trauma.

Comments

Post a Comment

Popular posts from this blog

Lignocaine Associated Systemic Toxicity (LAST)

  Lidocaine Associated Systemic Toxicity (LAST) Lidocaine Associated Systemic Toxicity (LAST) is a potentially life-threatening condition that occurs due to the excessive absorption of local anesthetics, particularly lidocaine, into the systemic circulation. LAST can result from inadvertent intravascular injection, overdose, or rapid absorption from highly vascularized areas.   Pathophysiology: Lidocaine, like other local anesthetics, works by blocking sodium channels, inhibiting the initiation and propagation of nerve impulses. However, when systemic levels of lidocaine become excessively high, these sodium channels are blocked in vital organs such as the heart and brain, leading to serious complications. Clinical Presentation: LAST can manifest with a variety of symptoms that often progress through two stages: Neurological Symptoms : Early signs include circumoral numbness, metallic taste, tinnitus, and dizziness. As toxicity increases, more severe symptoms such as seizures,...
Post a Comment
Read more

Various Methods of Shoulder Joint Reduction

  Shoulder joint dislocation can be reduced by a lot of explained maneuvers. Its better to learn them through some good videos from open source (YouTube and Vimeo) rather than memorizing  The various maneuvers for the reduction of a Dislocated Shoulder Joint are     1. Kochers Maneuver     2. FARES (Fast Reliable and Safe Technique)     3. Hennepin Technique (External Rotation Technique)     4. Milch Technique     5. Stimsons Technique (Gravitational Weight)     6. Hippodratic and Modified Hippocratic Technique     7. Cunningham Technique Kochers Maneuver Adduction-ExtRotation-Flexion-Internal Rotation The process must be very slow and its better to give some muscle relaxant and analgesic prior to the procedure. Cunningham Technique https://www.youtube.com/watch?v=HGIjEEg_PQQ FARES (FAst, REliable and Safe Technique) Small occilating movements while in extension and external rotation. Gradually this is incre...
Post a Comment
Read more

CRASH-3 TRIAL (Tranexamic Acid in Head Injury)

 
Post a Comment
Read more