Tom is admitted to the emergency department with an acute spinal cord injury. Methylprednisolone is contraindicated for treatment when the injury:
A. Is a high cervical lesion.
B. Occurred less than 4 hours ago.
C. Occurred less than 8 hours ago.
D. Occurred more than 8 hours ago.
Correct Answer: D. Occurred more than 8 hours ago.
Research has shown that steroids are ineffective when given more than 8 hours after acute spinal injury. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released a consensus statement in 2013 that the use of glucocorticoids in acute traumatic SCI is no longer recommended. This view was balanced by a position statement by the American Academy of Emergency Medicine stating that treatment with glucocorticoids remains an acceptable treatment option though not a standard.
Option A: In terms of the safety of high-dose methylprednisolone, Sauerland et al. performed a systematic review of approximately 2500 patients from 51 trials that involved the use of high-dose methylprednisolone. They found no evidence that methylprednisolone increased the risk of GI bleeding, wound complication, pulmonary complications, or death.
Option B: The pathogenesis of SCI can be divided into two stages. The first stage involves the initial physical trauma with resulting tissue damage. Following this stage, a cascade of destructive biological changes occurs, resulting in secondary injury. Most therapeutic strategies for SCI aim to mitigate these “secondary” events, which include inflammation, lipid peroxidation, and excitotoxicity.The pathogenesis of SCI can be divided into two stages. The first stage involves the initial physical trauma with resulting tissue damage. Following this stage, a cascade of destructive biological changes occurs, resulting in secondary injury. Most therapeutic strategies for SCI aim to mitigate these “secondary” events, which include inflammation, lipid peroxidation, and excitotoxicity.
Option C: Because glucocorticoids suppress many of these secondary events, investigators have explored its utility as SCI therapy. While there are compelling data in experimental models, randomized control trials (RCTs) have generally not demonstrated compelling efficacy.