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Summary Statement: The Use of Methylprednisolone in Acute Spinal Cord Injury

2001; Lippincott Williams & Wilkins; Volume: 26; Issue: Supplement Linguagem: Inglês

10.1097/00007632-200112151-00011

1528-1159

Michael G. Fehlings,

Nerve Injury and Rehabilitation

Methylprednisolone has become widely used in the management of acute spinal cord injury and is considered by many to represent a “standard of care.” This is largely based on the results of the NASCIS-2 randomized clinical trial and the subsequent NASCIS-3 study. 1–4 However, these trials have resulted in considerable controversy. Some clinicians have called into question whether the results of NASCIS-2 and NASCIS-3 provide convincing evidence to support the use of methylprednisolone in acute spinal cord injury and have raised concerns regarding potential risks of this intervention. 5–8 The articles in this section by Drs. Bracken and Hurlbert reflect the spectrum of opinion regarding the use of steroids in acute spinal cord injury. Members of the Spine Focus Panel extensively discussed the role of methylprednisolone in acute spinal cord injury but could not reach agreement on key points. While it was acknowledged that the NASCIS trials represent landmark clinical studies, no clear consensus could be reached on the appropriate use of steroids in acute spinal cord injury. Many members of the Spinal Focus Panel acknowledged that although methylprednisolone is only modestly neuroprotective, this drug is clearly indicated in acute spinal cord injury because of its favorable risk/benefit profile and the lack of alternative therapies. However, a significant minority was of the opinion that the evidence supporting the use of steroids in spinal cord injury was weak and did not justify the use of this medication. The Spine Focus Panel did agree that given the devastating impact of spinal cord injury and the modest efficacy of methylprednisolone, clinical trials of other therapeutic interventions are urgently required. Many panel members also felt that a reanalysis of the NASCIS data might help to resolve the controversies surrounding the use of steroids in acute spinal cord injury. Of note, Dr. Bracken has agreed to release the data of the NASCIS trials for “protocol-driven research by qualified investigators.” This willingness to share the NASCIS data is to be applauded and may lead to further insights into the most appropriate clinical indications for methylprednisolone in acute spinal cord injury. An editorial, which reflects the opinion of the Spinal Focus Panel Chair, regarding the use of steroids in acute spinal cord injury follows this summary statement and serves as a potential guide for clinicians.