From the Guidelines
Dexamethasone (Decadron) is recommended for treating spinal shock, with a dose of 96 mg/day, as it has been shown to improve ambulation in patients with spinal cord compression 1. The use of high-dose dexamethasone in spinal shock is supported by a randomized trial that demonstrated improved ambulation with administration of steroids (96 mg/d) compared to a control arm 1.
- The regimen should be started as soon as possible after the injury, ideally within a short timeframe.
- The total duration of treatment is typically short-term, and the medication should be tapered off gradually over a few days to avoid adrenal suppression.
- It's crucial to note that this treatment should only be given under close medical supervision in a hospital setting, as it can have significant side effects and interactions with other medications, with a reported toxicity profile of 29% side effects and 14% serious side effects 1.
- Dexamethasone works by reducing inflammation and swelling in the spinal cord, potentially limiting secondary damage and improving neurological outcomes.
- However, the use of high-dose steroids in spinal cord injury is controversial, and the decision to use this treatment should be made on a case-by-case basis, considering the potential benefits and risks for each individual patient, with a recommended minimum dose of 4 mg of dexamethasone every 6 hours, although the dose may vary 1.
- A randomized trial supported the use of high-dose steroids (96 mg/day) in carcinomatous metastatic spinal cord compression treated with radiotherapy, with improved ambulation rates in patients who received high-dose dexamethasone before radiotherapy compared to those who did not receive corticosteroids before radiotherapy 1.
From the FDA Drug Label
Shock There is a tendency in current medical practice to use high (pharmacologic) doses of corticosteroids for the treatment of unresponsive shock Although adverse reactions associated with high dose, short term corticosteroid therapy are uncommon, peptic ulceration may occur.
The role of Dexamethasone (Decadron) in spinal shock is not directly addressed in the provided drug label. However, it does discuss the use of high-dose corticosteroids, including dexamethasone, in the treatment of unresponsive shock.
- Key points:
- High-dose corticosteroid therapy may be used in unresponsive shock.
- Dexamethasone sodium phosphate injection dosages for shock have been suggested by various authors, but these are not specifically for spinal shock.
- Administration of high-dose corticosteroid therapy should be continued only until the patient's condition has stabilized and usually not longer than 48 to 72 hours.
- Adverse reactions associated with high-dose, short-term corticosteroid therapy are uncommon, but peptic ulceration may occur. 2
From the Research
Role of Dexamethasone in Spinal Shock
- Dexamethasone is used in the treatment of acute spinal cord injury, with studies showing improved outcomes in patients treated with dexamethasone compared to those not treated with corticosteroids 3, 4.
- The use of dexamethasone in spinal cord injury is recommended within the first hours after injury, as it has been shown to reduce inflammation and improve functional recovery 3, 4.
- Dexamethasone is also used to minimize the risk of cranial nerve injury during carotid endarterectomy, with studies showing a significant reduction in the incidence of temporary cranial nerve injuries 5.
- In cases of spinal cord compression caused by epidural tumor, dexamethasone has been shown to have a dose-related beneficial clinical effect, associated with an improvement of blood-spinal cord barrier breakdown and a reduction of the water content of the compressed cord 6.
- The mechanism of action of dexamethasone in spinal cord injury is thought to involve the inhibition of inflammation and the reduction of oxidative stress, which can contribute to secondary injury after spinal cord trauma 7.