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

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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.

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Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Ioannis Siasios, Vassilios Dimopoulos & John Pollina

  2. University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Ioannis Siasios

  3. Department of Neurosurgery, Kaleida Health, Buffalo, NY, USA

    Ioannis Siasios, Vassilios Dimopoulos & John Pollina

  4. Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece

    Konstantinos Fountas

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  1. Ioannis Siasios
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Correspondence to Ioannis Siasios.

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Comments

Jack Jallo and Shannon Clark, Philadelphia, USA

The authors chose five prospective RCTs evaluating postoperative dysphagia after administration of steroids. Four out of the five studies showed improvement in postop dysphagia. The only study that did not show significant difference was the study that included only one-level ACDFs. On the other hand, one RCT that was a double-blinded study with 112 patients who underwent >2-level ACDFs (by Jeyamohan et al.) showed significant improvement in postoperative dysphagia. This article’s level of evidence was even higher than other the four studies due to the double-blinded design. The other three studies that included multilevel ACDFs also showed better outcomes in treatment group. The authors should have explained their conclusion that “the usage of steroids in patients undergoing ACDF remains controversial” given the evidence they review. Perioperative steroids (especially intravenous steroids dexamethasone or methylprednisone) help with postsurgical dysphagia to some extent. These studies were all prospective RCTs, and authors acknowledge repeatedly that all studies were well designed. And yet, the primary conclusion that the authors repeat is that it remains controversial.

Luciano Mastronardi, Roma, Italy

This is an intriguing manuscript on the effect of steroids for dysphagia after anterior cervical procedures. Even if the topic is of particular relevance in the daily practice, only few articles were published in the literature. This interesting meta-analysis prompts cervical spine surgeons to think about a possible prospective multicenter study for a final statistical evaluation.

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Siasios, I., Fountas, K., Dimopoulos, V. et al. The role of steroid administration in the management of dysphagia in anterior cervical procedures. Neurosurg Rev 41, 47–53 (2018). https://doi.org/10.1007/s10143-016-0741-8

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  • DOI: https://doi.org/10.1007/s10143-016-0741-8

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