Five years prior to the 1990 publication of the Second National Acute Spinal Cord Injury Study (SNASCIS), a 24-year-old man sustained traumatic paraplegia, and was treated with 797 mg of dexamethasone over the ensuing 26 days. Within three years he developed symptomatic bilateral humeral head osteonecrosis. Although his total steroid dose was less than one-third of the comparable dose recommended by the SNASCIS, the duration of administration of the steroid was much longer. This case illustrates the importance of adhering to the guidelines established by the SNASCIS, especially regarding the 24-hour administration period.