Steroids have no place in the management of cervical myelopathy

Abstract

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults in Western society. Very little has been written about it in Nigeria. This would give the impression that it is rare in Nigeria. Unfortunately, this is not the case and having seen a few patients now in Abuja, we can appreciate some of the real issues. Patients with cervical spondylotic myelopathy are not being properly diagnosed and managed. It is often thought to be a disease of old age and part of life. Others feel that old age and infirmity preclude management and so patients are not referred to hospital. Families also at times prefer local management with traditional healers. Finally, patients are often treated only by general practitioners, general medicine physicians and neurologists. We have now seen a few patients who have been treated long term for CSM by neurologists without referral for surgical intervention. Patients having been seen are placed on long term steroid therapy, vitamin C and analgesics and neuropathic pain medicines such as Carbamazepine, Gabapentin and Pregabalin. Our perspective is that such treatment especially for moderate or severe CSM is of little benefit to address the fundamental and underlying problem in CSM. In our opinion, steroid use is not necessary and predisposes patients to diabetes, osteoporosis and avascular necrosis of the head of femur. The other two key problems in the past were poor availability of MRI scans and spine trained neurosurgeons.