Although a number of agents designed to prevent secondary metabolic spinal-cord injury are under investigation, the current standard of care is for the administration

of intravenous methylprednisolone. The protocol for steroid administration has been developed in a number of prospective, randomized trials, although these trials have generally excluded children during study accrual. The currently recommended guidelines for methylprednisolone are:

1. Treatment should be given only if the initial bolus dose can be given within 8 hours of injury.

2. 30 mg/kg IV bolus over 45 minutes followed by a 15-minute break.

4. If the initial bolus is given within 3 hours of injury, the drip should be discontinued after 23 hours. Some institutions follow the original guidelines, stopping methylprednisolone treatment in all patients after 23 hours.

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