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Steroids for acute spinal cord injury

2002; Cochrane; Linguagem: Inglês

10.1002/14651858.cd001046

1469-493X

Michael B. Bracken,

Nerve Injury and Rehabilitation

Background Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. Steroid treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. Objectives To review randomized trials of steroids for acute spinal cord injury. Search methods We searched the Cochrane Injuries Group specialised register, CENTRAL (issue 3, 2007), MEDLINE (to September 2007), and EMBASE (to September 2007). Files of the National Acute Spinal Cord Injury Study were reviewed as well as reference lists of relevant studies. Selection criteria All randomized controlled trials of steroid treatment for acute spinal cord injury in any language. Data collection and analysis Data have been extracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. Main results There are few trials in this area. One steroid has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post‐injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg over 15 minutes, with maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial results were replicated in a Japanese trial but not in the one from France. Data was obtained from the latter studies to permit appropriate meta‐analysis of all three trials. This indicated significant recovery in motor function after methylprednisolone therapy, when administration commenced within eight hours of injury. A more recent trial indicates that, if methylprednisolone therapy is given for an additional 24 hours (a total of 48 hours), additional improvement in motor neurologic function and functional status are observed. This is particularly observed if treatment cannot be started until between three to eight hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries. A modified regimen was found to improve recovery after surgery for lumbar disc disease. Authors' conclusions High‐dose methylprednisolone steroid therapy is the only pharmacologic therapy shown to have efficacy in a phase three randomized trial when administered within eight hours of injury. One trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours, if start of treatment must be delayed to between three and eight hours after injury. There is an urgent need for more randomized trials of pharmacologic therapy for acute spinal cord injury.