Steroids in Spinal Trauma Pros and Cons'

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Steroids in Spinal Trauma - Pros and Cons.

• Emma Borthwick
• RVH ICM Seminar
• 27th April 2007.

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Pros.
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Pathophysiology

• Traumatic SCI

Primary injury
Secondary injury
Hypoperfusion cell tissue damage
Steroids
Swelling Inflammation Glutamate release
(excitotoxicity) Free radical accumulation
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Prospective, Randomized Controlled Trials
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Retrospective Studies
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Effect of intravenous corticosteroids on death
within 14 days in 10 008 adults with clinically
significant head injury (MRC CRASH trial)
randomised placebo-controlled trialCRASH trial
collaborators The Lancet 2004 3641321-1328

• Previous evidence suggesting steroids reduce risk
  of death
• Aimed to recruit 20 000 patients
• Head injury GCSlt14 within 8 hrs
• 48 hr infusion of MP or placebo
• Recruitment stopped early
• MP group had higher risk of death from all causes

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Cons

• No convincing evidence that steroids alter
  clinical neurological outcome
• Generally not used by orthopedic spinal surgeons
  in NI
• There is evidence over safety fears and adverse
  events

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ConsSafety and adverse effects of steroids in
spinal trauma

• Increased incidence of infectious and septic
  complications
• Increased incidence severity of respiratory
  complications
• Increased incidence of pulmonary embolism
• Worsening of head injury outcome
• Increased incidence of gastrointestinal
  haemorrhage
• Increased incidence of pancreatitis
• Masking' of abdominal signs