Acute and Chronic Complications of High-Dose Corticosteroid Use in Patients with Spinal Shock: Systematic Revision

Background: During The use of methylprednisolone (MP) in patients with acute spinal cord injury has been widely debated due to its potential neurological benefits and associated risks of complications. While the administration of MP in the early hours following the injury has been adopted in many protocols, its use during surgical procedures remains controversial because of the high incidence of adverse effects. Materials and Methods: A systematic review of studies evaluating the use of MP during surgery in patients with acute spinal cord injury was conducted. The search included databases such as PubMed and the Cochrane Library, utilizing MeSH terms such as "methylprednisolone", "spinal cord injury", and "surgical complications". The selected studies included retrospective cohorts and controlled clinical trials. Results: The reviewed studies showed an increase in the incidence of severe complications, such as respiratory infections, gastrointestinal bleeding, and sepsis, in patients treated with methylprednisolone (MP) during surgical procedures. Some studies reported short-term motor improvements, but these were not consistent over the long term. Overall, patients receiving MP were at higher risk for complications like deep vein thrombosis and pneumonia compared to those who did not receive the drug (p < 0.01). These findings suggest that the risks associated with MP may outweigh its potential benefits in the surgical context. Conclusion: The use of prophylactic methylprednisolone during spinal stabilization surgery in patients with acute spinal cord injury is associated with a notable increase in the risk of severe complications. While some studies suggest initial motor improvements, the overall evidence points to significant risks, including infections and thrombotic events. These findings highlight the need to carefully reassess clinical guidelines regarding the use of MP in surgical settings and encourage exploration of alternative approaches that minimize potential adverse outcomes.