Questionnaire Survey of Spine Surgeons on the Use of Methylprednisolone for Acute Spinal Cord Injury

In Brief Study Design. A questionnaire survey. Objective. Estimate the use and justification of the steroid protocol for spinal cord injury (SCI) patients. Summary of Background Data. There remains significant debate over clinical benefits and potential complications of the steroid protocol for SCI patients. Methods. A survey was sent to spine surgeons requesting information on 1) specialization, 2) trauma center affiliation, 3) use of steroid protocol, 4) justification of using steroid protocol, and 5) SCI volume. Results. Responses were received from 305 surgeons. Fourteen (4.6%) surgeons used steroids only if initiated before their consult, 262 (85.9%) would initiate if within the accepted 8-hour timeframe, 20 (6.6%) did not use steroids at all, and 9 (3.0%) used a different protocol. Justification for steroids use: 65 improved recovery, 64 institutional protocol, 110 medicolegal reasons, and 26 did not personally initiate steroids. Eighteen surgeons listed both clinical benefit and institutional protocol, and 22 others listed both institutional protocol and medicolegal reasons. Conclusions. The majority (90.5%) of responding surgeons used the steroid protocol; however, only 24.1% used the steroid protocol due to a belief in improved clinical outcomes. A questionnaire survey of spine surgeons revealed the majority used the standard steroid protocol for treatment of SCI patients. Less than 25% believed in a perceived clinical benefit of this treatment. Position statements from respected societies have recommended the use of steroid treatment for acute SCI patients only as a treatment option but not as a standard or a guideline.