Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature.

BACKGROUND CONTEXT: Methylprednisolone has evolved during the 1990s, through the results obtained from the National Acute Spinal Cord Injury Studies NASCIS II and III, as a standard treatment in acute spinal injury. PURPOSE: To evaluate the scientific basic for the use of methylprednisolone in acute spinal cord injury. STUDY DESIGN: Systematic review of the accumulated literature. METHODS: Critical evaluation of the data obtained in the NASCIS II and III studies plus other accumulated literature. RESULTS: Analyses have been made on subgroups of the study populations, and the results were based on statistical artefacts. Furthermore, improved functional recovery shown by these studies was not clinically significant. CONCLUSION: There is insufficient evidence to support the use of methylprednisolone as a standard treatment in acute spinal cord injury.