Spinal cord compression (non-traumatic): Difference between revisions
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#Consult neurosurgery and/or rad onc
#Consult neurosurgery and/or rad onc
#Corticosteroid therapy
#Corticosteroid therapy
##No longer indicated.  
##Extremely controversial and perhaps no longer indicated in nontraumatic compression<ref>Coleman WP, 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; 13:185.</ref><ref> Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An
inappropriate standard of care. J Neurosurg 2000; 93(1 Suppl):1</ref>
##Consider emergent radiation, surgical intervention, and/or chemo therapy
##Consider emergent radiation, surgical intervention, and/or chemo therapy
==Steroids in Cord Compression==
==Steroids in Cord Compression==

Revision as of 12:07, 24 February 2014

Background

  • Most often from cancer

Diagnosis

  • MRI is study of choice
    • If unavailable consider CT myelography

Treatment

  1. Consult neurosurgery and/or rad onc
  2. Corticosteroid therapy
    1. Extremely controversial and perhaps no longer indicated in nontraumatic compression[1][2]
    2. Consider emergent radiation, surgical intervention, and/or chemo therapy

Steroids in Cord Compression

"Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death."

—Pharmacological therapy for acute spinal cord injury., Neurosurgery. 2013 Mar;72 Suppl 2:93-105[3]

Disposition

  • Admit

See Also

References

  1. ↑ Coleman WP, 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; 13:185.
  2. ↑ Hurlbert RJ: Methylprednisolone for acute spinal cord injury: An inappropriate standard of care. J Neurosurg 2000; 93(1 Suppl):1
  3. ↑ Hurlbert RJ et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar;72 Suppl 2:93-105 http://www.ncbi.nlm.nih.gov/pubmed/23417182
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