Snowmobiling can be fun. It could lead to tragedy as well; especially if you are drunk or not paying attention.

The patient in his thirties lost control of his snowmobile hitting a tree at high speeds. He was flown to the Emergency Room where he was noted to have no movement in both legs. High dose intravenous steroids were initiated to improve his functional recovery.

In the tertiary trauma center he was found to have severe thoracic spine subluxation with complete spinal cord transsection. Surgical stabilization was scheduled. Intravenous steroids were finished per protocol.

Giving IV steroids early after spinal cord injury makes physiologic sense. By reducing spinal cord edema and, even more importantly, reducing lipid peroxidation, you improve the patient’s chances for neurological recovery. It even worked in experiments on rats. The clinical evidence, though, is inconsistent. For the most part, the difference in functional recovery was minimal if significant at all. So, why are we doing it?

This might be another example of the physicians practicing defensive medicine. If the treatment MIGHT help, yet the evidence is inconsistent, you have to use it. Not so much for the patient’s sake but for the lawyers reviewing the chart later.

Can you, actually, do harm with high dose steroids? Absolutely, you can. Inhibiting immune response of the, otherwise, critically ill patient, you increase the risk of infection and sepsis. The patient on a ventilator will be at a higher risk for a ventilator associated pneumonia which will significantly increase the morbidity and mortality.

More evidence is needed to support or reject the use of steroids for the patients with a spinal cord injury. Meanwhile, do what you think is right…