Current Guidelines on Corticosteroid Use in Spinal Cord Injury

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SCI-GDG Guidelines on Corticosteroid Use in Acute Spinal Cord Injury

Consider a 24-hour infusion of high-dose methylprednisolone sodium succinate for adults who present within 8 hours of injury (SCI-GDG Grade Weak, Level Moderate).
Do not offer a 48-hour infusion of high-dose methylprednisolone sodium succinate (SCI-GDG Grade Weak, No direct evidence).
- Reference: Global Spine Journal 2017 Sep;7(3 Suppl):203

No clinical evidence to definitively recommend the use of any neuroprotective medication, including steroids, to improve functional recovery (CSCM Expert consensus, Strong agreement).
Stop the use of methylprednisolone as soon as possible in neurologically normal patients, and in patients whose previous neurologic symptoms have resolved, to reduce side effects (CSCM Expert consensus, Strong agreement).
- Reference: CSCM guideline on early acute management in adults with SCI (J Spinal Cord Med 2008;31(4):403)

Do not give methylprednisolone for acute spinal cord injury; high-dose corticosteroids are associated with adverse effects and death (AANS/CNS Level I).
- Reference: AANS/CNS recommendations for pharmacological therapy for acute SCI (Neurosurgery 2013 Mar;72 Suppl 2:93)

Do not use methylprednisolone, nimodipine, or naloxone in the acute stage of traumatic spinal cord injury to provide neuroprotection and prevent secondary deterioration.
- Reference: NICE guideline on spinal injury assessment and initial management (NICE 2016 Feb:NG41)

There are few data regarding the use of methylprednisolone with penetrating injuries.
Retrospective studies suggest a higher rate of complications and no evidence of benefit [85-87].
Most clinicians do not use glucocorticoids for penetrating spinal cord injury.
- References: Prendergast MR, Saxe JM, Ledgerwood AM, Lucas CE, Lucas WF. Massive steroids do not reduce the zone of injury after penetrating spinal cord injury. J Trauma. 1994 Oct;37(4):576-9; discussion 579-80. doi: 10.1097/00005373-199410000-00009. PMID: 7932887.
- Levy ML, Gans W, Wijesinghe HS, SooHoo WE, Adkins RH, Stillerman CB. Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis. Neurosurgery. 1996 Dec;39(6):1141-8; discussion 1148-9. doi: 10.1097/00006123-199612000-00014. PMID: 8938768.
- Heary RF, Vaccaro AR, Mesa JJ, Northrup BE, Albert TJ, Balderston RA, Cotler JM. Steroids and gunshot wounds to the spine. Neurosurgery. 1997 Sep;41(3):576-83; discussion 583-4. doi: 10.1097/00006123-199709000-00013. PMID: 9310974.