Methylprednisolone indication in Acute Spinal Cord Injury (ASCI)?

• In accordance with the previous guidelines, Methylprednisolone was indicated for acute spinal cord injury (ASCI).
• however, a recent guideline by the Congress of Neurological Surgeon (CNS) and the American Association of Neurological Surgeons (AANS) published in 2012 discourages steroid use in the management of ASCI. 
• The guideline clearly mentions that methylprednisolone is not recommended in the management of ASCI, and there is no class I or II evidence to support its use. 
• In stark contrast however, there is class I to III evidence showing that treatment with methylprednisolone is associated with harmful side effects. 

References: 

1. Anderson P. New CNS/AANS guidelines discourage steroids in spinal injury. Medscape. WebMD. Available from: http://www.medscape.com/viewarticle/781669#vp_1
2. Hadley MN et al. Guidelines for the management of acute cervical spine and spinal cord injuries. 2001. American Association of Neurological Surgeons. Available from: http://www.aans.org/en/education%20and%20meetings/~/media/files/education%20and%20meetingf/clinical%20guidelines/traumaguidelines.ashx
3. Hurlbert R et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar; 72: 93- 105. Available from: http://journals.lww.com/neurosurgery/Fulltext/2013/03002/Pharmacological_Therapy_for_Acute_Spinal_Cord.12.aspx

The 2012 guidelines clearly state that methylprednisolone is not recommended in the management of acute SCI, and that there is no class I or II evidence to support its use. In stark contrast, there is class I to III evidence that this treatment is associated with harmful side effects."