Corticosteroids

High-dose methylprednisolone has been shown to be effective in the treatment of blunt spinal cord injury. The National Acute Spinal Cord Injury Study (NASCIS) group conducted a series of multi-institutional studies to evaluate the efficacy of methylprednisolone in spinal trauma. 2 Methylprednisolone infusion resulted in improvement of both motor and sensory function in patients with complete and incomplete neurologic lesions. This positive outcome was dependent upon dosage of steroids and time of administration. The current recommended steroid protocol for victims of spinal injury with neurologic deficits is as follows:

1. Treatment must be started within 8 h of injury.

2. Methylprednisolone (30 mg/kg) bolus administered intravenously over 15 min.

3. This is followed by a 45-min pause.

4. A maintenance infusion of methylprednisolone (5.4 mg/kg per hour) is continued for 23 h.

NASCIS evaluated only blunt spinal cord injury. Patients with penetrating injuries were excluded from the study. The role of steroids in the treatment of penetrating cord injury is currently unclear.

The major neuroprotective mechanism of high dose methylprednisolone is its inhibition of free radical-induced lipid peroxidation. 25 Other proposed beneficial actions of methylprednisolone include its ability to increase levels of spinal cord blood flow, increase extracellular calcium, and prevent loss of potassium from injured cord tissue. Methylprednisolone is advocated in preference to other steroids because it crosses cell membranes more rapidly and completely.

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