Spine injuries

By Rob South

Dr. John Hurlbert is challenging the world’s medical community to stop the process of treating spinal cord injuries with the steroid

Hurlbert, a professor at the University of Calgary’s Faculty of Medicine, concluded the current practice of steroid use was improper after an extensive look into the history of steroid use and its results.

"There has been a lot of animal research over the past 20 years that originally found it attractive to take mechanisms on a molecular level that we know steroids have an affect on, and apply it to animal models of brain or spinal cord injury," explained Hurlbert. "As a result of those animal studies, there was a large human study that started in the late ’80s and was published in early 1991 that purported to show that steroids could be of benefit to people with spinal cord injuries. And that’s where the present practice originated from."

Hurlbert investigated the original study from 1991 and subsequent studies then pooled the data from all the studies and looked at what the overall outcomes were. After he examined the data, he determined steroid use had no long term benefits in treating spinal cord injuries. According to Hurlbert, these results were found because subsequent studies had a longer period of patient observation than the 1991 study.

"The data just does not support the widespread use of steroids," said Hurlbert. "Since Jan. 1 of this year, people with spinal cord injuries did not receive steroids in Alberta."

The change in practice was a direct result of Hurlbert’s research, and he hopes this practice will spread to other medical communities around the world.

"When we looked at the data in more detail and from a perspective that’s important to the patient, not a statistical perspective, it becomes clear that the effects of steroids is marginal and probably due to nothing more than random events," said Hurlbert. "When you looked at a subset of patients that was given steroids for two days [after the injury occurred] there was a subset that actually died from respiratory complications."

Though Hurlbert stated there is not enough data to confirm that 48 hours of steroid therapy can cause death, he does worry enough people may eventually be given the treatment to prove it.

"The evidence that 48 hours of steroids works is the same evidence that 48 hours of steroids kills due to respiratory compromise," said Hurlbert. "And in our opinion, they are both random events due to chance."

Hurlbert’s research was published in the latest issue of the Journal of Neurosurgery: Spine, which is considered one of the world’s top medical journals. It is Hurlbert’s hope the journal will help get the word out that steroids should be considered experimental and not standard care.

"I hope we can stop putting our resources into steroids, and concentrate our resources on other potential resources for spinal cord injuries that might be bigger and better," concluded Hurlbert. "To waste more resources on steroids I think won’t be in the best interest of spending health care and research dollars."

Leave a comment