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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  and
R. Moulton
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
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Abstract

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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
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 3 , August 2002 , pp. 236 - 239
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

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