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The Current Role of Steroids in Acute Spinal Cord Injury
Author(s):
Mohamad Bydon
,
Joseph Lin
,
Mohamed Macki
,
Ziya L. Gokaslan
,
Ali Bydon
Publication date
Created:
November 2014
Publication date
(Print):
November 2014
Journal:
World Neurosurgery
Publisher:
Elsevier BV
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Abstract
Acute spinal cord injury (ASCI) is a catastrophic event that can profoundly affect the trajectory of a patient's life. Debate continues over the pharmacologic management of ASCI, specifically, the widespread but controversial use of the steroid methylprednisolone (MP). Treatment efforts are impeded because of limitations in understanding of the pathobiology of ASCI and the difficulty in proving the efficacy of therapies. This review presents the pathophysiology of ASCI and the laboratory and clinical findings on the use of MP. The use of MP remains a contentious issue in part because of the catastrophic nature of ASCI, the paucity of treatment options, and the legal ramifications. Although historical data on the use of MP in ASCI have been challenged, more recent studies have been used both to support and to oppose treatment of ASCI with steroids. ASCI is a devastating event with a complex aftermath of secondary damaging processes that worsen the initial injury. Although the results of NASCIS (National Acute Spinal Cord Injury Study) II and III trials led to the widespread adoption of a high-dose MP regimen for patients treated within 8 hours of injury, subsequent studies have called into question the validity of NASCIS conclusions. Further evidence of the ineffectiveness of the MP protocol has led to declining confidence in the treatment over the last decade. At the present time, high-dose MP cannot be recommended as a standard of care, but it remains an option until supplanted by future evidence-based therapies. Copyright © 2014 Elsevier Inc. All rights reserved.
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IODP Expedition 400: NW Greenland Glaciated Margin
Author and article information
Journal
Title:
World Neurosurgery
Abbreviated Title:
World Neurosurgery
Publisher:
Elsevier BV
ISSN (Print):
18788750
Publication date Created:
November 2014
Publication date (Print):
November 2014
Volume
: 82
Issue
: 5
Pages
: 848-854
Article
DOI:
10.1016/j.wneu.2013.02.062
PubMed ID:
23454689
SO-VID:
45aa1ff0-7de1-4128-be0a-c37d1e876286
Copyright ©
© 2014
License:
https://www.elsevier.com/tdm/userlicense/1.0/
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