Megadose Steroid Therapy in Spinal Cord Injury: A Narrative Review

Objectives: To examine the controversies, advantages, and disadvantages of megadose steroid therapy, and investigate the historical progression and current treatment trends in acute spinal cord injury through a literature review.Summary of Literature Review: A literature review was conducted with the efficacy and side effects of megadose steroid therapy in the acute phase of spinal cord injury and current treatment guidelines and studied the status of steroid use in the Korean medical community.Materials and Methods: Review of the relevant articles. Results:The standard treatment for spinal cord injury has not yet been established, and the only treatment with megadose steroids that is clinically acceptable continues to be controversial due to ineffectiveness and side effects.The National Acute Spinal Cord Injury Studies (NASCIS), an early study that provided evidence for steroid use, and supporting studies recommended steroid use.But as studies questioning the effectiveness of steroid use and suggesting the risk of complications presented counterarguments, guidelines that do not recommend steroid use have been presented, and recent studies through meta-analysis also do not recommend steroid use.The actual prescription ratio of steroids for spinal cord injury is decreasing worldwide.In Korea, although prescription ratio of steroid is also decreasing, it is still high compared to other countries, then it is thought that awareness improvement and guideline reorganization are necessary.Conclusions: Megadose steroids have been recognized for their neuroprotective effects in the acute phase of spinal cord injury; however, their associated side effects have also been documented, and established treatment guidelines remain lacking, leading to ongoing debates.Since the NASCIS studies, evidence supporting steroid use has been insufficient, while research and meta-analyses highlighting the complications associated with steroid administration have emerged.Although the rate of steroid prescriptions has declined both domestically and internationally, it remains notably higher in South Korea compared to North America and Europe.