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Survey of Cervical Spine Research Society Members on the Use of High-Dose Steroids for Acute Spinal Cord Injuries

Schroeder, Gregory D. MD*; Kwon, Brian K. MD, PhD, FRCSC; Eck, Jason C. DO; Savage, Jason W. MD*; Hsu, Wellington K. MD*; Patel, Alpesh A. MD, FACS*

doi: 10.1097/BRS.0000000000000297
Health Services Research
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Study Design. A questionnaire survey.

Objective. To characterize surgeons' current perspectives on the administration of methylprednisolone for acute spinal cord injury (SCI) and determine how this has changed during the last 7 years.

Summary of Background Data. The determinants of and complications associated with off-label steroid use for acute SCI remain controversial.

Methods. A survey was sent to surgeon members of the Cervical Spine Research Society requesting information regarding their use of steroids for acute SCI. Determinants included surgeons' specialty, trauma center level, number of SCIs treated per year, severity of injury, and location of injury. These results were compared across groups as well as with a historical control.

Results. In the case of cervical complete and incomplete SCIs, 47.4% and 56.4% of respondents, respectively, reported using steroids. For complete and incomplete thoracolumbar spine injuries, the usage rate was 46.2% and 55.1%, respectively. There has been a significant (P < 0.0001) decrease in the number of surgeons using high-dose steroids in the treatment of acute SCIs when compared with a previous report in 2006 (56% vs. 89%).

More than 80% of respondents reported sepsis, active gastrointestinal bleeding, and SCI occurring earlier than 8 hours as contraindications. Seventy-one percent of respondents reported observing complications from the use of steroids, and 76.3% thought that the complications were severe enough to limit steroid use. Of the surgeons who used steroids for SCI, 26% thought that steroids improved neurological recovery, 19.2% used steroids to adhere to institutional protocol, and 25.6% stated they did not think steroids were beneficial but used them because of medicolegal concerns.

Conclusion. There has been a significant decrease in the number of surgeons using high-dose steroids for acute SCIs. Sepsis, gastrointestinal bleeding, and an injury occurring more than 8 hours prior to presentation were agreed upon as contraindications to steroid use.

Level of Evidence: 5

A survey was sent to members of the Cervical Spine Research Society requesting information regarding their use of steroids for acute spinal cord injury (SCI). The results were compared across groups as well as with a historical control; steroid use has decreased from 89% to 56% among spine surgeons for the treatment of acute SCI.

*Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia, Canada; and

Center for Sports Medicine and Orthopaedics, Chattanooga, TN.

Address correspondence and reprint requests to Gregory D. Schroeder, MD, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Ste 1350, Chicago, IL 60611; E-mail: gregdschroeder@gmail.com

Acknowledgment date: January 20, 2014. First revision date: February 15, 2014. Acceptance date: February 15, 2014.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States.

The manuscript includes unlabeled/investigational uses of the products/devices listed and the status of these is disclosed in the manuscript: high-dose methylprednisolone is Food and Drug Administration approved but not for the treatment of acute spinal cord injury. The use of steroids for this purpose is off-label.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, patents, royalties, stock/stock options, and grants/grants pending.

© 2014 by Lippincott Williams & Wilkins