Prospective Randomized Controlled Trial to Study the Effect of Local Steroids in the Retropharyngeal Space After Anterior Cervical Discectomy and Fusion

Abstract

Study Design: Prospective randomized controlled trial. Objective: To study the effect of local steroids in the retropharyngeal space after anterior cervical discectomy and fusion (ACDF) in reducing prevertebral soft-tissue swelling (PSTS) and complications associated with it. Methods: A total of 50 consecutive patients operated with ACDF were double-blinded randomized into 2 groups: steroids (25) and control (25). Triamcinolone in collagen sponge was used in the steroid group and normal saline in gelatin sponge in the control group. Patients’ lateral radiographs were taken on the immediate postoperative day; days 2, 4, and 6; at 2 weeks; and 2 and 6 months postoperatively. The PSTS ratio at C3 to C7 and PSTS index were calculated. Patients were clinically evaluated using the Visual Analogue Scale (VAS) score for odynophagia and radiating pain, modified Japanese Orthopedic Association Score (mJOA), and Neck Disability Index (NDI). Results: PSTS showed a significant reduction in the steroid group as compared with the control group on the immediate postoperative day; days 2, 4, and 6; and at 2 weeks. However, at 2 and 6 months, PSTS remained the same. VAS score for odynophagia also showed a significant difference between the 2 groups on the immediate postoperative day; days 2, 4, and 6; and 2 weeks postoperatively, with no significant difference at the 2- and 6-month follow-up. mJOA and NDI showed no significant difference between the 2 groups at the 2- and 6-month follow-up. Conclusion: Use of retropharyngeal steroids helps in reducing the postoperative odynophagia on a short-term basis without any complication.

Intraoperative Use of Topical Retropharyngeal Steroids for Dysphagia after Anterior Cervical Fusion: A Systematic Review and Meta-Analysis

“…Corticosteroids can promote apoptosis of osteoblasts and bone cells, which may affect bone healing as well as increase the risk of prosthetic joints. In this meta-analysis, although some studies reported cases of postoperative pseudarthrosis, but at subsequent follow-up, there were signs of bone nonunion in both groups, while excluding the possibility of a significant effect of steroids on bone healing [15]. However, this result should be interpreted with caution, because two of the eight studies did not report infection rates and four did not report pseu-darthrosis rates.…”

“…To compare the overall PSTS of the two groups, the mean PSTS at C3, 4, and 5 where edema was observed to be most pronounced was defined as the prevertebral soft-tissue swelling index (PSTSI). PSTSI eliminates interindividual differences, such as vertebral width or any other abnormalities in the cervical or retropharyngeal space, facilitating comparisons with other postoperative patients as well as with the patients themselves [14,15].…”

Aphagia Strongly Suspected to Be Caused by an Allergic Reaction to a Gelatin-based Hemostatic Agent after Anterior Cervical Decompression and Fusion for Central Cervical Cord Injury

“… 14 ) However, even if thickened soft tissue in the front of the vertebral body may cause dysphagia, swallowing rarely becomes impossible. 15 ) In this case, the retropharyngeal space the day after the operation increased to 15.8 mm, so the aphagia was due to the esophageal trismus.…”

Effect of perioperative steroids application on dysphagia, fusion rate, and visual analogue scale (VAS) following anterior cervical spine surgery: A meta-analysis of 14 randomized controlled trials (RCTs)

“…In total, 252 patients received intravenous steroids, 310 patients received topical steroids, and 619 patients served as controls. The corticosteroid treatment arms utilized IV dexamethasone ( 16 , 22 , 28 , 29 ) or methylprednisolone ( 31 , 33 ) or local injection of methylprednisolone ( 24 – 27 , 30 , 32 ) or triamcinolone ( 18 , 23 , 28 ).…”

“…Five studies reported numbers of fusion events at 1-year follow-up time and were included ( 18 , 22 , 23 , 28 , 29 ). There existed no significant difference between groups regarding fusion rate (OR = 0.87, 95% CI: 0.46–1.65), and no significant heterogeneity among these studies was found with a fixed-effect model ( I 2 = 0.0%, p = 0.999) ( Figure 6 ).…”