Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected.</jats:p> <jats:p>Clinical trial registration no.: NCT01065961 (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="clinicaltrials.gov" ext-link-type="uri" xlink:type="simple">clinicaltrials.gov</jats:ext-link>)</jats:p></jats:sec>

Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: A systematic review

“…The remaining 7 articles met inclusion criteria. Five articles were prospective randomized controlled trials [12][13][14][15][16] ; and two were retrospective case-control studies. 17,18 The results of the literature search are summarized in the PRISMA flow diagram (Figure 1).…”

“…level of evidence 1 [12][13][14][15][16] ; the retrospective studies (n=2) are graded as level of evidence 3. 17,18,25 Dysphagia was measured using a number of different modalities, which are summarized in Table 1.…”

“…13 In addition to these inconsistent results with dysphagia, there is concern about the adverse effects of steroids, such as delayed time to fusion and increased infection rates. 15,19 The use of both systemic and local steroids has been reported in previous studies.…”

“…2,4,10,11 One therapeutic intervention that shows promise is the use of perioperative steroids. [12][13][14][15][16][17][18] By reducing the inflammatory response, steroids should decrease dysphagia as well as pain in the postoperative period. 16 The use of steroids has resulted in decreased dysphagia incidence and severity as well as airway edema, in some studies 12,[15][16][17][18] ; however, in other studies the effect of steroids has been equivocal.…”

Servikal spondilotik miyelopati; anterior cerrahi girişimler

“…[55] Anterior servikal cerrahinin postansiyel olarak öl-dürücü bir komplikasyonu, ödem ve hematomdan kaynaklanan hava yolu obstrüksiyonudur. Emery ve arkadaşları, ciddi miyelopatisi olan hastaların tamamının ameliyattan sonra entübe şekilde izlenmesini önermişlerdir.…”