We enjoyed reading the huge and impressive study.1 We were pleased that the authors quoted our work from 1982, showing that it is still relevant 32 years later.2

Because of the recognised risks, neither Professor Masri nor Dr Silver have used steroids in the treatment of spinal injuries, apart from the very rare exacerbation when the neurological condition deteriorated and they thought steroids might help but they did not use them as a routine treatment. As a result of various systematic researches on the ill-effects of steroids, routine steroid administration is less frequently practised in the USA and Western Europe.