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IV steroids have not been associated with any significant complications
1%
16/1173
There is a significant decrease in cord edema seen on MRI after steroids are given
2%
28/1173
IV steroids have been linked to significant motor recovery in multiple studies
12/1173
The routine use of steroids is controversial, but can be given in the appropriate clinical circumstance
87%
1016/1173
IV steroids do not have an effect on spinal cord hemorrhage
8%
92/1173
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The administration of intravenous (IV) methylprednisolone for traumatic spinal cord injuries remains controversial but can be given in the appropriate clinical circumstances. Spinal cord injuries are devastating to patient function, quality of life, and are associated with a tremendous increase in treatment costs. They often occur in a bimodal age distribution with younger patients having high energy mechanisms and older patients from low-energy falls in the presence of a spondylotic spine. Historically, initial treatment of spinal cord injuries consisted of IV steroids to reduce additional cord damage from the inflammatory response and reperfusion injury. However, current literature has not demonstrated a clear clinical benefit and has demonstrated a higher risk of complications. Leypold et al. performed a retrospective study of MRI characteristics in 82 patients with traumatic spinal cord injuries treated with or without intravenous (IV) methylprednisolone. They reported a significant reduction in the extent of spinal cord hemorrhage in patients treated with IV steroids and no significant difference in the number of patients exhibiting spinal cord hemorrhage or effect on spinal cord edema. They concluded IV methylprednisolone may reduce the extent of spinal cord hemorrhage in patients with traumatic spinal cord injury if given in the acute injury period. Evanview et al. performed a systematic review and meta-analysis of four randomized controlled trials and 17 observational studies of traumatic spinal cord injuries treated with IV methylprednisolone. The pooled evidence from the included studies did not reveal a significant motor recovery benefit and an increased risk of gastrointestinal bleeding with IV methylprednisolone. They concluded the current evidence does not support the routine use of IV steroids for the treatment of traumatic spinal cord injuries. Fehlings et al. provided guidelines (AO Spine) for the treatment of acute spinal cord injuries. They reported there is a paucity of data on the use of steroids for acute spinal cord injuries but recommend administration for injuries presenting within 8 hours and continuing for a 24-hour interval. They do not recommend the administration of steroids after 8 hours of injury or continuing for 48 hours due to the side effect profile. Walters et al. provided guideline (AANS) for the treatment of acute cervical spinal cord injuries. Based on the existing evidence, the authors recommended against the use of corticosteroids regardless of the timing of presentation. The authors cited rationale was the lack of clinical benefit reported in the literature and the high complications associated with administration. Incorrect answers: Answer 1: IV steroids have been linked to an increased risk of gastrointestinal bleeding. Answer 2: There has been no significant effect on spinal cord edema with IV steroids. Answer 3: Only two randomized trials reported significant motor recovery, whereas two randomized trials and 17 observational studies did not. Answer 5: A retrospective study did report a significant improvement in the extent of spinal cord hemorrhage in patients that received IV steroids.
1.7
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