Introduction: Acute spinal cord injuries (ASCI) and their consequences still are a challenge for doctors of various specialities. Current concepts of ASCI pathophysiology underline the role of secondary damage therein membrane lipid peroxydation and nerve cells apoptosis. Hopes for effective decrease of these phenomenons were bound with methyloprednisolone therapy after encouraging results of American NASCIS I, II and III trials. Presently methyloprednisolone treatment is widely discussed and the efficacy is uncertain. Aim of paper: Authors basing on current literature present concepts of posttraumatic changes in spinal cord after ASCI, mechanisms of methyloprednisolone action, advantages and disadvantages of this therapy. Based on long term observations methyloprednisolone treatment does not fulfil expectations, furthermore NASCIS trials lack accurate evaluation and adverse reactions like gastro-intestinal bleeding, infections and prolonged hospitalisation outweigh benefits. Future directions of pharmacological treatment are presented. Conclusion: All gathered data suggest that methyloprednisolone therapy in ASCI is not efficient and can not be treated as therapeutical standard. Initial results of methyloprednisolone therapy were not confirmed in following studies. Current pharmacological research is focused on neuroprotective and antioxidant treatment e.g. erythropoetin, estrogen or activated autologic macrophages.