Steroids in acute spinal cord injury. An unproven standard of care

Since 1990s, methylprednisolone has become a widely prescribed therapy for improving the outcome of acute spinal cord injured victims and has considered a standard of care based. This have been claimed on the results of two randomized controlled trials (NASCIS II and III), even if the studies failed to demonstrate improvements due to methylprednisolone administration in any of the a priori hypothesis tested. Although, post hoc analyses were carefully constructed for evidencing minimal benefits of the steroid therapy in subgroups of patients and were publicized worldwide, these presumed benefit have been extended to all acute spinal cord injured patients. Further analyses of the papers, devoid of the participation of the authors, performed by external reviewers and evidence-based experts, failed to demonstrate clinically significant treatment effects. For this reason and for the consideration that high dose methylprednisolone could be harmful to the patients, the use of methylprednisolone in acute spinal cord injury cannot be recommended and cannot be considered a standard of care.