Case of the Month #38 Spinal Cord Injury

Published 27/04/2023

Is there evidence for pharmacological prevention of secondary spinal cord injury?

No.  Whilst high dose Methylprednisolone has been used historically in the management of the acute phase of SCI, the most recent NICE guidance does not recommend its use due to the relatively weak evidence of neurological improvement and increased incidence of adverse effect including hyperglycaemia and pulmonary embolus. There was also insufficient evidence for NICE to comment on the use of dexamethasone and NSAIDs in acute SCI. 

Further, NICE were unable to recommend the use of Nimodipine and Naloxone in the acute management of SCI due to minimal evidence of neurological improvement and available evidence of adverse events.