Management of acute spinal cord injury with corticosteroids

Objective of this report is to present and review the clinical effectivenes s and safety of corticosteroids in the treatment of patients with acute spi nal cord injury The analysis comprises randomised, controlled clinical tria ls of corticosteroids in acute spinal cord injury, such as the US multicent er National Acute Spinal Cord Injury Studies (NASCIS) I - III, and investig ations with historical patient control groups in comparison to corticostero id-treated patients. Only NASCIS-II was able to demonstrate a better 1-year motor recovery (acco rding to neurologic change scores) subsequent to application of high-dose m ethylprednisolone (MPS) (dosage: 30 mg/kg body weight (BW) on admission fol lowed by 5.4 mg/kg BW/h continuous 23 h-infusion) in those patients, who ha d been treated within 8 h after acute injury The analysed studies demonstra ted that a further increase in the dose of the corticosteroid applied or a prolongation of its application did not result in better spinal recovery On the contrary increasing corticosteroid doses were associated with an enhan ced rate of septic complications and a higher incidence of pneumonia, There was no difference in the 1-year morbidity or mortality between patients tr eated with or without corticosteroids, Neurological recovery of spinal func tions, general patient outcome and prognosis did not differ in patients irr espective of therapy with corticosteroids. This review of randomised, prospective trials of corticosteroids in acute s pinal cord injuries and subsequent studies with historical controls shows t hat there remain considerable uncertainties about their clinical effectiven ess. There is controversy in the available studies' data and the statistica l analyses performed. There are concerns about unclear functional-neurologi cal end points, potentially serious treatment-associated side effects and t he lack of proof for valid clinical benefits. Therefore, to include cortico steroids in the medical management of acute spinal cord injury remains the individual decision of the physician responsible for treatment.