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August 24, 1984

Methylprednisolone in Spinal Cord Injuries

Author Affiliations

University of Massachusetts Medical School St Vincent Hospital Worcester

JAMA. 1984;252(8):1009. doi:10.1001/jama.1984.03350080015008

To the Editor.—  The double-blind randomized trial of low- v high-dose methylprednisolone in acute spinal cord injury was well conceived and executed (and should have been, perhaps, because it sports 20 authors!).1 It also called for Dr Kobrine's2 appropriate editorial. I wish to quibble only with Dr Kobrine's designation of "the next logical study, namely, a prospective randomized study comparing normal-steroid therapy with placebo treatment." Dr Kobrine is, of course, correct. However, one might equally conceive that randomized study as the previous "logical study," since, despite the long, inadequately validated use of corticosteroids in nervous system injuries, the appropriate (logical) step would have been to begin with a controlled, randomized trial.3 Lacking that, the use of these powerful agents—at any dose—has left unresolved the possibility that some or all patients may have become worse because of this treatment. This possibility is, of course, always present with the