Skip to main content Accessibility help
×
Home
Hostname: page-component-559fc8cf4f-qpj69 Total loading time: 0.211 Render date: 2021-03-08T07:28:01.130Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Why Do You Prescribe Methylprednisolone for Acute Spinal Cord Injury? A Canadian Perspective and a Position Statement

Published online by Cambridge University Press:  02 December 2014

R.J. Hurlbert
Affiliation:
Department of Clinical Neurosciences, Foothills Hospital and Medical Centre, Calgary AB, Canada
R. Moulton
Affiliation:
Department of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
Rights & Permissions[Opens in a new window]

Abstract

Objective:

To determine the practice patterns for methylprednisolone administration for patients with acute spinal cord injury (SCI) within the spinal surgery community across Canada, and the reasons behind these patterns.

Methods:

Canadian neurological and orthopedic spine surgeons were surveyed at their respective annual meetings with a questionnaire asking seven questions with respect to their practice standards.

Results:

Sixty surgeons completed the survey representing approximately two-thirds of surgeons treating acute SCI within Canada. The NASCIS III dosing regimen is the most commonly prescribed steroid protocol. However, one-quarter of surgeons do not administer steroids at all. Of those who administer methylprednisolone, most do so because of peer pressure or out of fear of litigation.

Conclusion:

The vast majority of spine surgeons in Canada either do not prescribe methylprednisolone for acute SCI, or do so for what might be considered the wrong reasons. These results demonstrate the need for an evidence-based practice guideline. The Candian Spine Society and the Canadian Neurosurgical Society fully endorse the recommendations of the steroid task force (see preceding paper).

Résumé:

RÉSUMÉ: Objectif:

Déterminer les modalités d’administration de la méthylprednisolone chez les patients présentant une ésion aiguë de la moelle épinière (LMÉ) en chirurgie de la moelle épinière au Canada et les raisons sous-jacentes à ces pratiques.

Méthodes:

Nous avons fait un sondage auprès des neurochirurgiens et des orthopédistes lors de leur congrès annuel respectif au moyen d’un questionnaire incluant sept questions sur leurs standards de pratique.

Résultats:

Soixante chirurgiens ont complété le sondage, soit environ les deux tiers des chirurgiens qui traitent des LMÉ au Canada. Le régime posologique NASCIS III est le protocole d’administration de stéroïdes le plus couramment prescrit. Cependant, le quart des chirurgiens ne prescrivent pas du tout de stéroïdes. Parmi ceux qui administrent de la méthylprednisolone, la plupart le font à cause de la pression des pairs ou par crainte d’une poursuite.

Conclusions:

La grande majorité des chirurgiens qui traitent des traumatisés de la moelle au Canada ne prescrivent pas de méthylprednisolone pour une LMÉ ou le font pour ce qui pourrait être considéré comme de mauvaises raisons. Ces résultats démontrent qu’il existe un besoin quant à l’établissement de lignes directrices basées sur des données probantes. La Canadian Spine Society et la Canadian Neurosurgical Society appuient entièrement les recommandations du groupe de travail sur les stéroïdes (voir l’article précédent).

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Bracken, MB, Shepard, MJ, Collins, WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the second national acute spinal cord injury study. N Engl J Med 1990; 322:14051411.CrossRefGoogle ScholarPubMed
2. Bracken, MB, Shepard, MJ, Collins, WF, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year followup data. J Neurosurg 1992; 76:2331.CrossRefGoogle ScholarPubMed
3. Bracken, MB, Shepard, MJ, Holford, TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. JAMA1997; 277:15971604.Google Scholar
4. Bracken, MB, Shepard, MJ, Holford, TR, et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow-up. J Neurosurg 1998; 89:699706.CrossRefGoogle ScholarPubMed
5. Hurlbert, RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg 2000; 93:17.Google ScholarPubMed
6. Nesathurai, S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma Injury Infect Crit Care 1998; 45:10881093.CrossRefGoogle ScholarPubMed
7. Coleman, WP, Benzel, E, Cahill, DW, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000;13:185199.CrossRefGoogle ScholarPubMed
8. Short, DJ, El Masry, WS, Jones, PW. High dose methylprednisolone in the management of acute spinal cord injury - a systematic review from a clinical perspective. Spinal Cord 2000; 38:273286.CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 180 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 8th March 2021. This data will be updated every 24 hours.

Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Why Do You Prescribe Methylprednisolone for Acute Spinal Cord Injury? A Canadian Perspective and a Position Statement
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Why Do You Prescribe Methylprednisolone for Acute Spinal Cord Injury? A Canadian Perspective and a Position Statement
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Why Do You Prescribe Methylprednisolone for Acute Spinal Cord Injury? A Canadian Perspective and a Position Statement
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *