Synopsis
Avoid ineffective and harmful high-dose steroid neuroprotection after traumatic cord injury, distinguish non-traumatic steroid indications, and prioritise oxygenation, perfusion, imaging, decompression and specialist spinal care.
- NICE says not to use methylprednisolone, nimodipine or naloxone in the acute stage after traumatic spinal-cord injury for neuroprotection.
- Do not start a historical high-dose methylprednisolone regimen because presentation is within an alleged treatment window; timing does not create a NICE indication.
- Run ABCDE with spinal protection, support a weak high-cervical airway and ventilation early and prevent even brief hypoxaemia.
Key red flags
New weakness, sensory level, sacral change, respiratory muscle weakness or sphincter dysfunction after trauma requires emergency cord assessment and must not be delayed while debating steroid administration.
Investigation priorities
Confirm mechanism, level, completeness and immediate physiological threats.
Define bony injury, displacement and canal fragments.
Management branches
A patient has neurological signs after acute spinal trauma.
- Run ABCDE with safe spinal alignment, support ventilation, control haemorrhage and prevent hypoxia, hypotension and hypothermia.
- Document motor, sensory and sacral findings and arrange complete CT and MRI after CT for attributable cord abnormality.
Key medicines
Methylprednisolone for traumatic cord neuroprotectionDo not administer a high-dose methylprednisolone bolus or infusion for neuroprotection in the acute stage of traumatic spinal-cord injury; NICE recommends against this treatment.