The role of steroid administration in the management of dysphagia in anterior cervical procedures

Abstract

Dysphagia is a common postoperative symptom for patients undergoing anterior cervical spine procedures. The purpose of this study is to present the current literature regarding the effect of steroid administration in dysphagia after anterior cervical spine procedures. We performed a literature search in the PubMed database, using the following terms: "dysphagia," "ACDF," "cervical," "surgery," "anterior," "spine," "steroids," "treatment," and "complications." We included in our review any study correlating postoperative dysphagia and steroid administration in anterior cervical spine surgery. Studies, which did not evaluate, pre- and postoperatively, dysphagia with a specific clinical or laboratory methodology were excluded from our literature review. Five studies were included in our results. All were randomized, prospective studies, with one being double blinded. Steroid administration protocol was different in every study. In two studies, dexamethasone was used. Methylprednisolone was administrated in three studies. In four studies, steroids were applied intravenously, while in one study, locally in the retropharyngeal space. Short-term dysphagia and prevertebral soft tissue edema were diminished by steroid administration, according to the results of two studies. In one study, prevertebral soft tissue edema was not affected by the steroid usage. Furthermore, short-term osseous fusion rate was impaired by the steroid administration, according to the findings of one study. The usage of steroids in patients undergoing anterior cervical spine procedures remains controversial. Multicenter, large-scale, randomized, prospective studies applying the same protocol of steroid administration and universal outcome criteria should be performed for extracting statistically powerful and clinically meaningful results.

Corticosteroid Administration to Prevent Complications of Anterior Cervical Spine Fusion: A Systematic Review

“…Of the 31 full-text articles included in the primary screening stage, 9 studies (total population: 246 414) were eligible for further consideration: 7 RCTs 16 , 27 – 32 and 2 nonrandomized studies (one cohort 33 and one case-control study 34 ). The other 22 articles were excluded because they were case reports, 13 , 35 – 39 studies without a control group for steroid, 40 – 45 seminar abstracts, 46 – 48 reviews, 49 , 50 commentaries, 51 , 52 or studies without sufficient data on steroid use. 53 – 55 Table 1 shows characteristics of the included studies.…”

An enhanced recovery after surgery pathway: association with rapid discharge and minimal complications after anterior cervical spine surgery

“…In contrast to our ERAS pathway for lumbar surgery, procedure-specific evidence supported the inclusion of topical methylprednisolone for anterior cervical procedures. 26,37 Postoperatively, patients were encouraged to attempt oral intake as soon as they had recovered from anesthesia and a bedside swallow evaluation was considered satisfactory by the responsible nurse. A 5-hour mandatory PACU stay for observation and 2 swallowing tests (i.e., patient has to eat twice) are required for all patients before discharge.…”

“…18 Other interventions that minimize this risk include restriction of intraoperative intravenous fluid administration 11 and topical methylprednisolone. 26,37 We included these 3 elements of care in our anterior cervical ERAS pathway, but not in our lumbar decompression pathway, based on procedure-specific benefits to recovery. Interestingly, the use of topical methylprednisolone was among the ERAS process elements with the lowest rates of compliance in our study.…”

Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion

“…While the evidence for steroid use is still limited by risk of bias and a small number of studies, systematic reviews are generally in favor of steroid use. A recent review found that the incidence and severity of dysphagia and pre-vertebral soft-tissue swelling are generally lower in the steroid group, while airway compromise and LOS were inconclusive [23]. Complications related to steroid use were rare and fusion rates were comparable.…”