Is the role of steroids in acute spinal cord injury now resolved?

Steroids have long been used in the context of acute spinal cord injury but the evidence for doing so is limited. The second National Acute Spinal Cord Injury Study trial had the potential to provide such evidence for the first time, as this was a placebo controlled, prospective, randomized trial. From the outset, however, some clinicians found the methodology and consequently the results unsatisfactory. This concern has been revisited within the evidence-based framework of critical appraisal of the accumulation of clinical studies. High-dose methylprednisolone cannot be justified as a standard treatment in acute spinal cord injury within current medical practice.