Spinal Cord Injury and Methylprednisolone.
Krishna Sharma, MS, DNB
Department of Neurosurgery
B & B Hospital
Kathmandu University Teaching
Spinal cord injury (SCI) is a devastating condition, leaving the most productive group of population disabled for the rest of their lives. over the years, attempts have been made to enhance recovery. Search for a drug that prevents or reduces secondary spinal injury by counteracting oxygen free radicals is going on. On this endeavor, steroid was initially used empirically based on animal studies for almost three decades before controlled trials were started to find efficacy especially of methylprednisolone succinyle succinate (MPSS).
The landmark study was National Spinal Cord Injury Study (NASCIS) which concluded the benefit of MPSS in acute SCI if used within 8 hours and it quickly became an implied standard of care. There were many other studies conducted during and after NASCIS trial which independently analyzed the trial. Most of the studies stressed concerns about the statistical analysis, randomization, and clinical end points and put question marks on its statistical validity and the clinical benefits of MPSS. The role of the steroid was questioned once again and MPSS has become no more than a treatment option only in many trauma centers.
Nepalese people are at high risk group of spinal cord injury but ironically the geographical and economical condition has made it almost impossible for them to use whatever the advantage of MPSS would have. In this article review of relevant literature has been done in the context of Nepal.
methylprednisolone ,National Spinal Cord Injury Study (NASCIS), spinal cord injury, steroid