Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone

Abstract

IntroductionProlonged intubation is associated with various ear, nose, and throat (ENT) complications, notably paresis or paralysis of the vocal cords [13,14]. Such complications may arise even after intubation of short duration [3,4,7] and regardless of the type of surgery. In reports of cervical spine surgery through the anterior approach, these complications have been noted and attributed to the surgical maneuvers as well as to intubation [1,2,10,11,12]. Moreover, these procedures may lead to other complications Abstract Cervical spinal surgery through anterior approaches can lead to ear, nose and throat (ENT) complications, some of which, such as obstruction of upper airways by edema, are potentially life threatening. The purpose of this study was to evaluate the incidence of various categories of ENT lesions and to determine whether preventive treatment with methylprednisolone (Mp) is useful in this indication. In a prospective trial, 236 patients who were undergoing anterior cervical spine surgery were separated into two groups, a control group (group I: 158 patients) and a group receiving 1 mg/kg of Mp intravenously at the end of the operation and 12 and 24 h later (group II: 78 patients). All 236 patients underwent nasofibroscopic examination by an ENT specialist the day before the operation and 24 and 36 h after the operation. The lesions observed during these examinations and reported symptoms such as uncomfortable sensation, odynophagia, or dysphagia were compared between the two groups (χ 2 or Mann-Whitney test) in terms of relative risk, with a confidence interval of 95%. Quantitative findings were compared using Student's t-test (P<0.05). Demographic characteristics and duration of endotracheal intubation were comparable in the two groups. The ENT examination was considered abnormal in 30 patients of group I and 15 patients of group II preoperatively (NS). It was abnormal in 146 patients of group I (92%) and 46 patients of group II (59%) postoperatively. Altered vocal cord motility was noted in six patients of group I and two patients of group II. The relative risk was 1.6 (CI: 1.3-1.9). Postoperatively, 130 patients in group I and 56 of group II (NS) reported unwanted symptoms. The observed lesions were significantly more severe in group I (P<0.001), involving primarily the pharyngeal wall, the arytenoids, and the vocal cords. The results of this study indicate that ENT complications of anterior cervical spinal surgery are diminished by administration of Mp. Systematic ENT examination is warranted before this type of operation.

Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study

“…The authors found a risk of vocal cord paralysis of 2.6% in the steroid group, compared to 3.8% in the control (not statistically significant). 16 …”

Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

“…Anterior plating contributes to an immediate stabilization that enables osseous fusion and the latter avoids prolonged neck brace use, allowing for early cervical mobilization and a shorter hospitalization. [1][2][3][4][5][6][7][8][9][10] Despite its widespread use and the relative simplicity of the technique, the risk of potential complications still ranges from 5% to 35%. [1][2][3]8 Some complications have a low risk, such as pharyngoesophageal edema, small hematoma, infection, or transitory recurrent laryngeal or hypoglossal nerve lesions, whereas others are life-threatening, such as epidural abscess, mediastinitis, or edema and hemorrhage with upper airway involvement.…”

“…Anterior cervical fixation through different devices has been used for multiple pathologies, such as traumatism, compressive myelopathy, or spinal infections since 1967. [1][2][3][4][5][6][7][8][9] It is a broadly developed technique in neurosurgery with a reported complication rate of 5%-35%. 1 Clinical evolution is usually satisfactory and well tolerated, although serious complications can occur, such as mediastinitis, severe hemorrhage, or epidural abscess.…”

“…1 Clinical evolution is usually satisfactory and well tolerated, although serious complications can occur, such as mediastinitis, severe hemorrhage, or epidural abscess. [1][2][3] Surgical material for fixation displacement is the origin of approximately 5% of the complications, with 2% requiring revision surgery. 1,4 Pharyngoesophageal lumen perforation is rarely seen.…”

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population

“…Antibiotics are typically used following spinal surgery to prevent or treat infections at the surgical site. As these complications can impair swallowing function, and lead to secondary restrictions of pharyngeal movement or epiglottic deflection, the use of steroid treatment or antibiotics post-operatively has potential to improve swallowing outcomes [23, 24]. In the studies reviewed, steroids and antibiotics appeared to contribute to improved swallowing function when used in addition to other swallowing interventions, primarily tube feedings [12, 13].…”