New guidelines from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons recommend against the use of steroid injections for acute spinal cord injuries.
Previously the injections were recommended “with consideration to the risk/reward profile” as determined by a physician. But a growing body of research of the last decade led the association to reverse its earlier guidelines on the use of steroid injections for spinal cord injuries (SCIs).
“Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death,” the authors of the guidelines wrote.
They stated that there is “no consistent or compelling medical evidence of any class to justify administration of MP[steroid injection] for acute SCI.”
In issuing the updated guidelines, researchers from the Congress of Neurological Surgeons conducted a meta-analysis of 28 studies on the effects of steroid injections on patients with acute spinal cord injuries. The trials tested the efficacy of two steroids, methylprednisolone (MP) and ganglioside (GM-1).
They discovered that there was “inconsistent” evidence on the beneficial effects of MP. In fact several studies indicated that MP is associated with a significant increase in the risk of infections, pneumonia, GI hemorrhage, and mortality. One study which included over 10,000 patients with head injury suggested that high-doses of MP increased the likelihood of death, regardless of injury severity.
Only two studies tested GM-1; one pilot study found that GM-1 did help, but since it was a small study with no placebo control, it was considered to be of low-quality evidence. The other study concluded that GM-1 had no significant effect on patients with spinal cord injuries.
Steroid injections made headlines earlier this year after a fungal meningitis outbreak was tied to a group of epidural steroid injections used to treat patients with back pain. The outbreak sparked new scrutiny over steroid injections, which are commonly used to relieve back pain associated with lumbar radiculopathy, disc herniation, and spinal stenosis.
Although epidural injections can provide temporary, moderate relief for these conditions, they can carry adverse effects such as a weakening of the muscle and spinal bones and a disruption of the natural hormone balance. The long-term effects of epidural steroid injections are still unclear.
Instead of risking the adverse effects of steroid injections for back pain, patients may considering opting for asafe, conservative treatment, chiropractic care. A new study showed that chiropractic adjustments provide the same level of relief as epidural injections, but without the added risks and costs.
Hulbert R, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery 2013; 72:93-105. doi: 10.1227/NEU.0b013e31827765c6.