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Evaluating Steroid Use in Acute Spinal Cord Injury: Evidence from a Pan-American Symposium

This summary reviews critical findings on steroid administration for a 20-year-old male with acute C4-5 spinal cord injury, as discussed at the Pan-American Symposium in Santiago, Chile, on October 7, 2003. The presentation evaluated the potential benefits and harms of steroids, analyzing epidemiological data indicating a prevalence of 40 cases per million annually, typically in young males. Key findings from randomized trials suggest modest benefits in motor function recovery yet highlight no significant differences in mortality or adverse effects. The conclusion indicates that while early treatment may yield slight improvements, safety concerns persist due to limited trial power.

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Evaluating Steroid Use in Acute Spinal Cord Injury: Evidence from a Pan-American Symposium

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  1. Acute Spinal Cord Trauma Robert L Wears, MD, MS Practice Guidelines: A Pan-American Symposium Santiago de Chile 7 October 2003

  2. Critical Question • 20 yr old male fell 5 meters • C4-5 fracture – dislocation • Motor deficit • Should he be given steroids? • What is the evidence for benefit? • What is the evidence for harm?

  3. Epidemiology • ~ 40 per million population annually • Typically • Young (20 – 35) • Male • Major disability • Shortened life expectancy • Major cost

  4. Study Selection • Randomized or quasi-randomized trials • Patients admitted for acute spinal cord injury • Exclude nerve root only, cauda equina syndrome • Outcome measures • Recovery of motor function (6 weeks, 6 months, 1 yr) (0 – 70 scale | 14 muscles 0-5) • Mortality

  5. Studies Included

  6. Studies Excluded

  7. Efficacy (Overall)

  8. Efficacy (< 8 hrs) *pooled at either 6 mo or 1 yr

  9. 24 Vs 48 Hours Treatment Mean (SD)

  10. Safety • Mortality, wound infection, GI bleed • No significant difference • Wide CI • Mortality RR .24 to 1.25 • Acute trauma studies low powered • Sauerland 2000 systematic review • 51 trials (including back surgery), > 2000 pts • No significant difference mortality, GI bleed, infection

  11. Conclusion • Benefit is modest at best • 5 – 8 points on 70 point scale • Class B • Minimum clinically important benefit undefined • Must be given early to be effective • No convincing evidence of harm • Low power limits safety assessment

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