AANS and CNS now say no to steroids in acute spinal cord injury patients


As part of its new guidelines for acute cervical and spinal cord injuries, published in Neurosurgery, the Joint Section on Disorders of the Spine and Peripheral Nerves of the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) no longer recommends the use of steroids in acute spinal cord injury in the first 24 to 48 hours after an injury is sustained. 

Previously, the use of steroids in acute cervical spine and spinal cord injury was recommended along as the risks and benefits of using the intervention were considered. However, the new recommendation states: “Administration of methylprednisolone for the treatment of acute spinal cord injury is not recommended.” According to a press release, the standard was revised because of a lack of medical evidence supporting the benefits of this drug’s use in the clinical setting. It stated that the guidelines’ findings indicate strong evidence that “high-dose steroids are associated with harmful side effects including death.” 

“The authors present a compelling case from high-quality clinical studies demonstrating a greater propensity for such medication to harm rather than benefit patients with spinal cord injuries,” said Daniel K Resnick, professor of Neurological Surgery at the University of Wisconsin School of Medicine and Public Health, and president-elect of the CNS.  “Overall, this update of the guidelines is an impressive accomplishment. It represents the ‘state of the literature’ with regard to the treatment of patients with cervical spine and spinal cord injuries and is a useful guide to help clinicians make important decisions in the care of these patients.”

The new guidelines, which were last published in 2002, contain 112 recommendations centred on 22 topics related to the care, assessment, imaging and treatment of patients with acute cervical spine and spinal cord injuries. They are the culmination of a 15-month volunteer effort by the Joint Section.

In all, the new Gguidelines include 19 Level I recommendations, each supported by Class I medical evidence. These include: assessment of functional outcomes, assessment of pain after spinal cord injuries, radiographic assessment, pharmacology, diagnosis of AOD, cervical subaxial injury classification schemes, paediatric spinal injuries, vertebral artery injuries, and venous thromboembolism.

Resnick said: “These new Guidelines reflect the leadership of the CNS as the premier provider of education and scientific exchange among neurosurgeons worldwide.  In this role, we dedicate significant resources to support the production of high-quality clinical practice guidelines as a means to improve the quality and safety of patient care, as the guidelines illustrates, and as a way to preserve patient access to valuable therapies.”

This new guideline will be addressed in-depth during three unique presentations at the 2013 CNS Annual Meeting, October 19-23, in San Francisco.