The current role of steroids in acute spinal cord injury

Mohamad Bydon, Joseph Lin, Mohamed Macki, Ziya L. Gokaslan, Ali Bydon

Research output: Contribution to journalReview article

54 Citations (Scopus)

Abstract

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.

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

Original languageEnglish (US)
Pages (from-to)848-854
Number of pages7
JournalWorld Neurosurgery
Volume82
Issue number5
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Spinal Cord Injuries
Methylprednisolone
Steroids
Therapeutics
Wounds and Injuries
Standard of Care

Keywords

  • Acute spinal cord injury
  • ASCI
  • ASIA classification system
  • Methylprednisolone
  • Steroids

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Bydon, M., Lin, J., Macki, M., Gokaslan, Z. L., & Bydon, A. (2014). The current role of steroids in acute spinal cord injury. World Neurosurgery, 82(5), 848-854. https://doi.org/10.1016/j.wneu.2013.02.062

The current role of steroids in acute spinal cord injury. / Bydon, Mohamad; Lin, Joseph; Macki, Mohamed; Gokaslan, Ziya L.; Bydon, Ali.

In: World Neurosurgery, Vol. 82, No. 5, 01.11.2014, p. 848-854.

Research output: Contribution to journalReview article

Bydon, M, Lin, J, Macki, M, Gokaslan, ZL & Bydon, A 2014, 'The current role of steroids in acute spinal cord injury', World Neurosurgery, vol. 82, no. 5, pp. 848-854. https://doi.org/10.1016/j.wneu.2013.02.062
Bydon, Mohamad ; Lin, Joseph ; Macki, Mohamed ; Gokaslan, Ziya L. ; Bydon, Ali. / The current role of steroids in acute spinal cord injury. In: World Neurosurgery. 2014 ; Vol. 82, No. 5. pp. 848-854.
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