Corticosteroids in the Treatment of Spinal Cord Injuries

After the initial tissue damage associated with a spinal cord injury, the inflammatory sequelae is controllable. The inflammatory response is illustrated through tissue ischemia, oxidative stress, inflammatory, and immune responses. Steroids such as Methyl prednisone are utilized in the reduction of oxidative stress as it is a primary degenerative event post trauma[1][2]. Additionally, higher doses have illustrated neuroprotective and immunosuppressive capacities through the release of interleukins, reducing Ca2+ aggregation, and necrosis limiting the progression of ischemia[1][2].

Pharmacokinetics

Oral and intravenous forms are prescribed for systemic disorders such as arthritis, blood disorders, allergic reactions, and immune disorders[2]. The biological half-life is also to be considered as the therapeutic range as is between 1.8 and 5.2 hours[3]. Other modes of administration such as spinal, inhaled, and local injections are prescribed to  SCI and patients with tendinopathies to limit systemic leakage of the steroid [1][2].

Adverse Effects

Noted complications such as wound infections, sepsis, and pneumonia are prevalent in patients with spinal cord injuries. Gastrointestinal and collagenous tissue disruption have been exhibited with long-term use of MP[2]. The catabolic effects of glucocorticoids on various tissue such as bone, ligament, and tendon are well-documented. Reduction of bone density in both patients with osteoporosis and arthritis is common[3][4]. In addition, this class of steroids may lead to muscle atrophy, hypertension, diabetes exaggeration, glaucoma, and cataracts[2]. These side effects emphasize the need for the PT to maintain a watchful eye and communicate with the physician if there is a need to limit glucocorticoid therapy.

Physical Therapy Implications

The therapist must be mindful of the systemic effects and their respective presentation. Osteoporosis patients that are prescribed glucocorticoids have an increased incidents of compression fractures[4]. This limits the interventions available to the therapist, particularly high-velocity manipulations. Tendon and ligament ruptures are prevalent as collagen synthesis is disturbed[4]. To limit the accompanying adverse effects, strengthening bone and musculature through weight bearing activities is recommended.

Back to Pharmacological Management of Spinal Cord Injuries.

  1. 1.0 1.1 1.2 Manchikanti, L., Cash, K. A., Pampati, V., & Falco, F. J. (2014). Transforaminal epidural       injections in chronic lumbar disc herniation: A randomized, double-blind, active-control trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25054399
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Singh, P. L., Agarwal, N., Barrese, J. C., & Heary, R. F. (2012). Current therapeutic strategies for inflammation following traumatic spinal cord injury. Neural Regeneration Research, 7(23), 1812–1821. http://doi.org/10.3969/j.issn.1673-5374.2012.23.008
  3. 3.0 3.1 Ciccone, C. D. (2016). Pharmacology in rehabilitation (5th ed.). Philadelphia: F.A. Davis Company.
  4. 4.0 4.1 4.2 Hachemi Y, Rapp AE, Picke AK, Weidinger G, Ignatius A, Tuckermann J. Molecular mechanisms of glucocorticoids on skeleton and bone regeneration after fracture. J Mol Endocrinol. 2018;61(1):R75-R90.