From the Guidelines
Steroid treatment is not recommended for spinal cord infarction, as it does not improve neurological outcomes and may increase the risk of infectious complications. The French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury, published in 2020, state that early administration of steroids does not improve post-traumatic neurological outcomes 1. This recommendation is based on three randomized controlled trials that investigated the role of methylprednisolone in patients with traumatic spinal cord injury, which found no significant difference in neurologic improvement and a higher rate of infectious complications in the steroid group 1.
Some key points to consider when evaluating the use of steroids in spinal cord infarction include:
- The lack of high-quality evidence supporting the use of steroids in spinal cord infarction 1
- The potential risks associated with steroid therapy, including hyperglycemia, immunosuppression, and gastrointestinal bleeding
- The importance of initiating rehabilitation concurrently with medical management for optimal outcomes
In terms of specific treatment protocols, it is essential to prioritize individualized care and weigh the potential benefits and risks of steroid therapy. However, based on the current evidence, steroid treatment is not recommended for spinal cord infarction 1. Instead, focus should be placed on providing supportive care and initiating rehabilitation as soon as possible to optimize outcomes.
From the FDA Drug Label
In general, high dose corticosteroid therapy should be continued only until the patient’s condition has stabilized; usually not beyond 48 to 72 hours
The recommended duration of steroid treatment following a spinal cord infarction is not beyond 48 to 72 hours, or until the patient's condition has stabilized 2.
From the Research
Recommended Duration of Steroid Treatment
The recommended duration of steroid treatment following a spinal cord infarction is based on the time of initiation of treatment.
- If methylprednisolone is administered within 3 hours of injury, the treatment regimen should be maintained for 24 hours 3, 4, 5.
- If methylprednisolone is initiated 3 to 8 hours after injury, the treatment regimen should be maintained for 48 hours 3, 4, 5.
Evidence from Studies
Studies have shown that methylprednisolone sodium succinate improves neurologic outcome up to one year post-injury if administered within eight hours of injury 4, 5.
- The initial North American trial results were replicated in a Japanese trial but not in the one from France 4, 5.
- A more recent trial indicates that if methylprednisolone therapy is given for an additional 24 hours (a total of 48 hours), additional improvement in motor neurologic function and functional status is observed 3, 4, 5.
Controversy and Limitations
The use of methylprednisolone in acute spinal cord injury is a contentious issue due to limitations in understanding the pathobiology of the condition and the difficulty in proving the efficacy of therapies 6.
- Some studies have called into question the validity of the NASCIS conclusions, leading to declining confidence in the treatment over the last decade 6.
- There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment 7.