From the Guidelines
The standard steroid regimen for spinal cord compression is high-dose dexamethasone, typically starting with a loading dose of 10-100 mg intravenously, followed by 4-24 mg every 6 hours, as recommended by the most recent guidelines 1. The most common approach is 10 mg IV initially, then 4 mg every 6 hours. Treatment should begin immediately upon suspicion of cord compression, even before imaging confirmation, as rapid intervention is critical to preserve neurological function.
Key Considerations
- The duration of steroid therapy depends on the underlying cause and response to treatment, but is typically continued until definitive treatment (such as surgery or radiation) is implemented, after which a gradual taper is recommended to avoid adrenal insufficiency 1.
- Steroids work by reducing inflammation and edema around the compressed spinal cord, which helps preserve neurological function while definitive treatment is arranged.
- Patients should be monitored for common steroid side effects including hyperglycemia, increased infection risk, gastrointestinal bleeding, and psychiatric effects.
- Gastric protection with a proton pump inhibitor is advisable during high-dose steroid treatment.
Additional Recommendations
- The steroid regimen should be accompanied by urgent imaging (preferably MRI) and consultation with neurosurgery or radiation oncology for definitive management 1.
- Spinal cord compression is an emergency that requires simultaneous local radiotherapy, which should be started as soon as possible, and surgery should be used in the case of bone fragments within the spinal route 1.
From the FDA Drug Label
Dexamethasone sodium phosphate injection is generally administered initially in a dosage of 10 mg intravenously followed by four mg every six hours intramuscularly until the symptoms of cerebral edema subside. The steroid regimen for spinal cord compression is not explicitly stated in the provided text, but for cerebral edema, which may be related, the dosage is 10 mg intravenously followed by 4 mg every six hours intramuscularly.
- The response is usually noted within 12 to 24 hours.
- The dosage may be reduced after two to four days and gradually discontinued over a period of five to seven days. 2
From the Research
Steroid Regimen for Spinal Cord Compression
The steroid regimen for spinal cord compression is as follows:
- Dexamethasone 16 mg daily should be administered to symptomatic patients as soon as spinal cord compression is diagnosed or suspected 3
- High-loading-dose corticosteroids should be avoided 3
- High-dose dexamethasone as an adjunct to radiotherapy has been shown to improve treatment outcomes in patients with metastatic spinal cord compression from solid tumours 4
- A bolus of 96 mg intravenously, followed by 96 mg orally for 3 days and then tapered in 10 days, has been used in clinical trials 4
Dosage and Administration
The dosage and administration of steroids for spinal cord compression vary depending on the specific clinical scenario:
- For acute spinal cord injury, methylprednisolone sodium succinate has been shown to improve neurologic outcome up to one year post-injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg over 15 minutes, with maintenance infusion of 5.4 mg/kg per hour infused for 23 hours 5, 6
- For malignant epidural spinal cord compression, high-dose corticosteroids (e.g. dexamethasone, 10-100 mg intravenously, followed by 16 to 100 mg/d in divided doses) should be started as soon as the diagnosis is suspected 7