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Congress Of Neurological Surgeons Recommends Against Use Of Steroids In Acute Spinal Cord Injury

Thu, 03/21/2013 - 12:35pm

For the first time, the Joint Section on Disorders of the Spine and Peripheral Nerves of the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons issued a recommendation against the use of steroids in acute spinal cord injury in the first 24 to 48 hours after an injury is sustained.  This represents a change from the Section's previously issued guidelines in 2002.  The new 2013 guidelines have the potential to drastically impact the standard of care recommended for spinal cord injury patients.

The new Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries were published in the March, 2013, issue of Neurosurgery, the peer-reviewed journal of the CNS.  The guidelines contain 112 recommendations centered on 22 topics related to the care, assessment, imaging and treatment of patients with acute cervical spine and spinal cord injuries.  The new guidelines are the culmination of a 15-month volunteer effort by the Joint Section.

The use of steroids in acute cervical spine and spinal cord injury (SCI) was previously recommended with consideration to the risk/reward profile, as evaluated by the physician.  The new recommendation states, "Administration of methylprednisolone (MP) for the treatment of acute SCI is not recommended."  The standard has been revised based on lack of medical evidence supporting benefits of this drug' use in the clinical setting. 

In fact, the report's findings indicate strong evidence "high-dose steroids are associated with harmful side effects including death."  

"The authors present a compelling case from high-quality clinical studies demonstrating a greater propensity for such medication to harm rather than benefit patients with spinal cord injuries," said Daniel K. Resnick, M.D., Professor of Neurological Surgery at the University of Wisconsin School of Medicine and Public Health, and President-Elect of the CNS.  "Overall, this update of the Guidelines is an impressive accomplishment.  It represents the 'state of the literature' with regard to the treatment of patients with cervical spine and spinal cord injuries and is a useful guide to help clinicians make important decisions in the care of these patients."

In all, the new Guidelines include 19 Level I recommendations, each supported by Class I medical evidence. These include:

  • Assessment of Functional Outcomes (1)
  • Assessment of Pain After Spinal Cord Injuries (1)
  • Radiographic Assessment (7)
  • Pharmacology (2)
  • Diagnosis of AOD (1)
  • Cervical Subaxial Injury Classification Schemes (2)
  • Pediatric Spinal Injuries (1)
  • Vertebral Artery Injuries (1)
  • Venous Thromboembolism (3)

Dr. Resnick added, "These new Guidelines reflect the leadership of the CNS as the premier provider of education and scientific exchange among neurosurgeons worldwide.  In this role, we dedicate significant resources to support the production of high-quality clinical practice guidelines as a means to improve the quality and safety of patient care, as the guidelines illustrates, and as a way to preserve patient access to valuable therapies."

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