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Steroids and Gunshot Wounds to the Spine

Heary, Robert F. MD; Vaccaro, Alexander R. MD; Mesa, Joseph J. MD; Northrup, Bruce E. MD; Albert, Todd J. MD; Balderston, Richard A. MD; Cotler, Jerome M. MD

Clinical Studies

OBJECTIVE: The second National Acute Spinal Cord Injury Study demonstrated that there were neurological benefits from "spinal cord injury" doses of methylprednisolone for blunt spinal cord injuries. In this review, we examined the relative risk/benefit ratio of intravenously treating spinal gunshot wound victims with steroids.

METHODS: A retrospective review was conducted of 254 consecutive patients who were treated between 1979 and 1994 for gunshot wounds to the spine (C1-L1) and a spinal cord injury. Three subgroups were established based on the administration of the steroids methylprednisolone (National Acute Spinal Cord Injury Study 2 protocol), dexamethasone (initial dose, 10-100 mg), and no steroids. All patients who received steroids were initially treated at another hospital and then transferred. No patients received steroids at our institution. The data analyzed included neurological outcome and infectious and noninfectious complications.

RESULTS: No statistically significant neurological benefits were demonstrable from the use of steroids (methylprednisolone, dexamethasone). Infectious complications were increased in both groups receiving steroids (not statistically significant). Gastrointestinal complications were significantly increased in the dexamethasone group (P = 0.021), and pancreatitis was significantly increased in the methylprednisolone group (P = 0.040). The mean duration of follow-up was 56.3 months.

CONCLUSION: In this retrospective, nonrandomized review, no neurological benefits were detectable from intravenously administered steroids after a gunshot wound to the spine. Both infectious and noninfectious complication rates were higher in the groups receiving steroids. Patients who sustain a spinal cord injury secondary to a gunshot wound to the spine should not be treated with steroids until the efficacy of such treatment is proven in a controlled study.

Division of Neurological Surgery (RFH), University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey; Departments of Orthopaedic Surgery (ARV, TJA, RAB, JMC) and Neurological Surgery (BEN), Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania; and the Rothman Institute (ARV, JJM, TJA, RAB), Pennsylvania Hospital, Philadelphia, Pennsylvania

Received, December 18, 1995. Accepted, April 7, 1997.

Reprint requests: Robert F. Heary, M.D., Center for Neurological Surgery, Suite 7300, 90 Bergen Street, Newark, NJ 07103.

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