Retropharyngeal Steroids and Dysphagia Following Multilevel Anterior Cervical Surgery

Abstract

4.

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

“…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). …”

“…17,18,25 Dysphagia was measured using a number of different modalities, which are summarized in Table 1.…”

“…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.…”

Local steroids and dysphagia in anterior cervical discectomy and fusion—does the employment of rhBMP-2 make their use a necessity?

“…They found that dysphagia was significantly lower among patients receiving steroids, compared to those with no steroids, at six and twelve weeks after surgery. Interestingly, the incidence of postoperative prevertebral soft tissue swelling was reduced immediately after surgery in the steroid group, but showed no difference between the steroid and the placebo groups 12 weeks after surgery (19). It may be hypothesized that the increased incidence of dysphagia may be associated with the inflammatory effect of BMP, thus local application of steroids could decrease the incidence of dysphagia.…”

“…However, the same group of researchers reported delayed esophageal perforation, as a significant adverse event occurring after the local administration of steroids in the retropharyngeal space (18). Koreckij et al, reported their experience from locally applying a saturated collagen sponge with methylprednisolone, in patients undergoing multi-level ACDFs (19). They found that dysphagia was significantly lower among patients receiving steroids, compared to those with no steroids, at six and twelve weeks after surgery.…”