Methylprednisolone for Spinal Cord Injury: Do Its Benefits Outweigh Its Risks?

The use of the corticosteroid methylprednisolone for spinal cord injury was widely accepted and considered the standard of care for a long time.

However, its use has become very controversial over time.

To help you decide whether the benefits outweigh the risks or not, this article will go over the pros and cons of using methylprednisolone for spinal cord injury.

Methylprednisolone for Spinal Cord Injury

Methylprednisolone has anti-inflammatory properties that can help reduce swelling.

After a spinal cord injury, it is crucial to stabilize the spinal cord as quickly as possible to minimize the amount of damage.

There are 2 types of damage that can occur after a spinal cord injury: primary and secondary.

Primary damage is caused by the traumatic event that compresses the spinal cord. Secondary damage is caused by how your body reacts to the primary damage.

For example, if you get into a car accident, the primary damage consists of the immediate outcomes of the impact. Secondary damage is what happens as your body reacts to the primary damage. It can include swelling, reduced blood flow, excitotoxicity, and scarring.

Primary damage is instantaneous and cannot be reduced, but secondary damage can.

It suggested that high doses of methylprednisolone within 8 hours following a spinal cord injury can help promote neurologic recovery and minimize secondary damage.

Controversy Surrounding Methylprednisolone for Acute Spinal Cord Injury

Methylprednisolone was widely accepted and considered the standard of care for acute spinal cord injuries; however, its use has become controversial over time.

In the 2002 Guidelines for the Treatment of Acute SCI, methylprednisolone-use was recommended. However, in the 2013 update, the recommendation was against methylprednisolone use, even though evidence has not changed much.

Those in favor of methylprednisolone-use argue that spinal cord injuries are extremely time-sensitive, and every bit of treatment can help maximize outcomes.

In contrast, physicians against methylprednisolone-use argue that the benefits are moderate at best and do not outweigh the risks.

Side Effects of Methylprednisolone

So what exactly are the risks associated with methylprednisolone?

Side effects of methylprednisolone include:

• Respiratory infections
• Urinary tract infections
• Hyperglycemia
• Gastrointestinal hemorrhage
• Steroid-induced myopathy
• All-cause mortality

These are very serious complications that can develop after using methylprednisolone, which is why use of the corticosteroid has been drastically reduced throughout the years.

Do the Benefits of Methylprednisolone Outweigh Its Risks?

A 2016 study found that SCI patients were in favor of methylprednisolone use. Even after learning about its dangerous side effects, many believed that the potential to achieve even the slightest bit of neurological recovery was worth it.

Ultimately, the use of methylprednisolone is up to the physician and should be discussed with the patient.

However, there are times when the patient is unconscious and the physician must act at their own discretion.

Now that you’re aware of the pros and cons of using methylprednisolone for acute spinal cord injury, do you think its benefits outweigh its risks?