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

Adenikinju, Abidemi; Halani, Sameer H.; Rindler, Rima S.; Gary, Matthew F.; Michael, Keith W.; Ahmad, Faiz U.

doi:10.14444/4009

Cited by 16 publications

(9 citation statements)

References 30 publications

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“…Many spine surgeons worry that steroids negatively impact bony fusion rates and are reluctant to use steroids. Our results demonstrated that there was no difference in fusion rates at 1-year follow-up between the steroids group and control group, which were consistent with those of prior studies of perioperative steroids ( 18 , 22 , 29 , 39 , 41 ). Nevertheless, the steroids may hinder early fusion.…”

Section: Discussionsupporting

confidence: 92%

“…Cheng et al ( 40 ) reviewed 3 RCTs and 2 retrospective cohort studies, and concluded that local corticosteroid application could reduce the incidence and severity of dysphagia following ACDF. Adenikinju et al ( 41 ) reviewed 5 RCTs and 2 retrospective cohort studies, and concluded that patients received systemic and local steroids benefit from reductions in rate and severity of dysphagia postoperatively. However, our finding is a novelty because we performed a qualitative synthesis of RCTs and discuss dysphagia without the differences in time points.…”

Section: Discussionmentioning

confidence: 99%

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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)

Zhang

Yang²,

Shen³

et al. 2022

Front. Surg.

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ObjectiveTo conduct a high-level meta-analysis of the RCTs to evaluate perioperative steroids use in the management of fusion rate, dysphagia, and VAS following anterior cervical spine surgery for up to 1 year.MethodsWe searched the database PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, Ovid, and ClinicalTrials.gov without time restriction to identify RCTs that evaluate the effectiveness of perioperative steroids after anterior cervical spine surgery. A subgroup analysis was undertaken to investigate the effects of intravenous and local steroids. This study was registered in the PROSPERO database prior to initiation (CRD42022313444).ResultsA total of 14 RCTs were eligible for final inclusion. This meta-analysis showed that steroids could achieve lower dysphagia rate (p < 0.001), severe dysphagia rate within 1 year (p < 0.001), lower VAS scores at both 1 day (p = 0.005), 2 weeks (p < 0.001) and shorter hospital stay (p = 0.014). However, there was no significant difference between the two groups regarding operation time (p = 0.670), fusion rates (p = 0.678), VAS scores at 6 months (p = 0.104) and 1 year (p = 0.062). There was no significant difference between intravenous and local steroid administration regarding dysphagia rates (p = 0.82), fusion rate (p = 1.00), and operative time (p = 0.10).ConclusionSteroids intravenously or locally following anterior cervical spine surgery can reduce incidence and severity of dysphagia within 1 year, VAS score within 2 weeks, and shorten the length of hospital stay without affecting fusion rates, increasing the operating time, VAS score at 6 months and 1 year.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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)

Zhang

Yang²,

Shen³

et al. 2022

Front. Surg.

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“…Theoretically, a lesser rate of dysphagia in the early post-operative period would provide a proof of concept that minimally invasive tubular approaches, in fact, reduce soft-tissue trauma and their related complications. Worldwide rates of dysphagia are reported to be around 8.5 (5.7-11.3%, 95% confidence interval) as reported by Shriver et al in their meta-analysis of 14 papers evaluating post-operative dysphagia after ACDF 28 , among them, the greatest rate of dysphagia (39%) was reported by Keppler on a cohort study with mean follow-up of 1.5 months 1 , becoming also the paper with the shortest follow-up, which translates in a high dysphagia rate in the early post-operative period, providing evidence of the important role of soft-tissue trauma in the genesis of dysphagia, a fact that can help understand why steroids have proofed effective in reducing early post-operative dysphagia [32][33][34] driven by their known anti-inflammatory effects. Conversely, our present series results report a 9% rate of dysphagia by 1-month follow-up, presenting a 9% dysphagia rate in day-1 post-operative that fully recovered by the end of follow-up.…”

Section: Discussionmentioning

confidence: 98%

Dysphagia rates after minimally invasive tubular approach to the anterior cervical spine

Romero-Rangel¹,

Soriano-Solis²,

Rodríguez-García³

et al. 2023

CIRUE

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Introduction: Cervical spine surgery (anterior cervical spine surgery [ACSS]) is a commonly indicated to provide neurological decompression, correct deformity, and preserve stability. Current series report good to excellent results, but a number of patients suffer from dysphagia with reported rates as high as 80%. Materials and methods: Retrospective cohort of patients undergoing ACSS (anterior cervical discectomy and fusion [ACDF]; and arthroplasty, total disc replacement [TDR]) from 2013 to 2017 by a single surgeon. We collected demographic data, surgical outcomes, clinical outcomes, and dysphagia incidence and magnitude (visual analog scale [VAS]), we analyzed results with SPSS 22. Results: A total of 81 patients operated from 2013 to 2018, ACDF was performed in 70, and TDR was performed in 11, mean surgical time was 156.8, mean neck pain and radicular pain VAS reduced significantly in both groups (p < 0.01). Dysphagia was encountered in 18 ACDF patients, and one TDR patient. Overall dysphagia rate was 9.1% in day-1 post-operative, with mean 0.27 magnitude (standard deviation [SD] 0.4) in ACDF group and 0.18 (0.6 SD) in TDR group, 1-month follow-up dysphagia rate was 0%. Conclusions: Minimally invasive techniques may reduce post-operative dysphagia related to soft-tissue trauma, to 9% in day-1 post-operative (as compared to 39%), and to 0% (as compared to 8.5% reported worldwide) by 1-month follow-up.

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“…Postoperative dysphagia may be due to endotracheal intubation, retraction of the oesophagus, and soft tissue inflammation. Preoperative systemic steroid treatment leads to a reduction of dysphagia severity, with no increase in infectious complications [15]. During this period, a liquid diet and gargling with lukewarm water are advised.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Subaxial Spine Injuries Managed With 2-Level Anterior Cervical Corpectomy and Fusion: A Prospective Study

et al. 2018

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ObjectiveTo evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone–filled titanium mesh cage. MethodsThis study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. ResultsAccording to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12–48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. ConclusionTwo-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

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

Abstract: Background

Cited by 16 publications

References 30 publications

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)

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)

Dysphagia rates after minimally invasive tubular approach to the anterior cervical spine

Functional Outcomes of Subaxial Spine Injuries Managed With 2-Level Anterior Cervical Corpectomy and Fusion: A Prospective Study

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