A 25-year-old sustains a complete cervical cord injury (ASIA Impairment Scale Grade A) at C5 level in a motor vehicle accident. Regarding acute management, the current evidence-based recommendation for high-dose methylprednisolone is:
- A Not recommended as standard of care due to lack of proven neurological benefit and significant harm (pneumonia, sepsis) ✓
- B Mandatory within 8 hours — standard of care per NASCIS II/III
- C Recommended in all patients for the first 48 hours post-injury
- D Only recommended for incomplete injuries within 3 hours
Explanation
Despite early NASCIS II (1990) and NASCIS III (1997) studies suggesting benefit, subsequent analysis and systematic reviews have concluded that high-dose methylprednisolone (MPSS) is NOT recommended as standard of care for acute spinal cord injury. Current AO Spine and AANS/CNS guidelines classify MPSS as a Treatment Option (not recommended) due to marginal, questionable neurological benefit and significant adverse effects (increased rates of sepsis, pneumonia, gastrointestinal bleeding, and death). Individual centers may use it as a medical option after informed consent. This represents an important change from older teaching — a paradigm shift examined in current NEET PG.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.