Abstract
Purpose
To conduct a high-level systematic review of the literature to evaluate intravenous and local steroid use in the management of dysphagia after anterior cervical spine surgery.
Methods
We searched the database PubMed, EMBASE, Clinical key, the Cochrane library and Wiley Online Library without time restriction using the terms ‘dysphagia’ or ‘odynophagia’ or ‘swallowing disorder,’ ‘steroid,’ ‘anterior cervical spine surgery.’ Randomized controlled trails (RCTs) were selected, and effects of intravenous and local steroids were investigated from these studies.
Results
The initial search yielded 67 citations. Six of these studies met the inclusion and exclusion criteria. All of them were prospective RCTs which were evaluated as level 1 evidence. One study found that perioperative intravenous steroid use is not effective in reducing severity of early postoperative dysphagia after one-level ACDF, while five studies suggested that perioperative intravenous and local steroid use seemed to be more effective on reducing incidence and severity of early dysphagia after multilevel ACSS. One double-blinded study still found that locally administered depomedrol on a collagen sponge significantly decreases early dysphagia incidence and severity after ACSS using low-dose BMP.
Conclusions
Perioperative intravenous and local steroid use could reduce incidence and severity of early dysphagia after ACSS postoperatively, especially for multilevel surgeries. For the patients underwent revision surgery or at high risk for pseudarthrosis having to use BMP during surgery, locally administered depomedrol on a collagen sponge was suggested to decrease early dysphagia incidence and severity after ACSS.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Liu JM (2017) The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: a prospective study. PLoS ONE 12(3):e0173364
Yang Y (2016) A meta-analysis of the incidence of patient-reported dysphagia after anterior cervical decompression and fusion with the zero-profile implant system. Dysphagia 31(2):134–145
Joaquim AF (2014) Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J 14(9):2246–2260
Anderson KK, Arnold PM (2013) Oropharyngeal dysphagia after anterior cervical spine surgery: a review. Glob Spine J 3(4):273–286
Zeng JH, Zhong ZM, Chen JT (2013) Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors. Arch Orthop Trauma Surg 133(8):1067–1071
Danto J (2012) Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol 24(4):350–355
Cho SK, Lu Y, Lee DH (2013) Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J 95-b(7):868–873
Rihn JA (2011) What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res 469(3):658–665
Riley LH (2010) Postoperative dysphagia in anterior cervical spine surgery. Spine (Phila Pa 1976) 35(9 Suppl):S76–S85
Kasimatis GB (2009) Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg 111(1):18–27
Singh K (2013) Incidence and risk factors for dysphagia after anterior cervical fusion. Spine (Phila Pa 1976) 38(21):1820–1825
Kalb S (2012) Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg 77(1):183–187
Olsson EC, Jobson M, Lim MR (2015) Risk factors for persistent dysphagia after anterior cervical spine surgery. Orthopedics 38(4):e319–e323
Lee MJ, Bazaz R, Furey CG, Yoo J (2007) Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J 7(2):141–147
Carucci LR, Turner MA, Yeatman CF (2015) Dysphagia secondary to anterior cervical fusion: radiologic evaluation and findings in 74 patients. AJR Am J Roentgenol 204(4):768–775
Chen CJ (2013) Dysphagia following combined anterior-posterior cervical spine surgeries. J Neurosurg Spine 19(3):279–287
Shi S (2016) Risk factors for dysphagia after single-level anterior cervical decompression with arthroplasty or fusion: a prospective study comparing 2 zero-profile implants. World Neurosurg 95:148–155
Tian W, Yu J (2017) The role of C2–C7 angle in the development of dysphagia after anterior and posterior cervical spine surgery. Clin Spine Surg 30(9):E1306–E1314
Mehra S, Heineman TE, Cammisa FP (2014) Factors predictive of voice and swallowing outcomes after anterior approaches to the cervical spine. Otolaryngol Head Neck Surg 150(2):259–265
Wu B, Song F, Zhu S (2016) Reasons of dysphagia after operation of anterior cervical decompression and fusion. Clin Spine Surg 78(F2):250–258
Netterville JL, Koriwchak MJ, Winkle M (1996) Vocal fold paralysis following the anterior approach to the cervical spine. Ann Otol Rhinol Laryngol 105(2):85–91
Kang SS (2014) The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery. Eur Spine J 23(8):1694–1698
Chen Z (2012) Tracheal traction exercise reduces the occurrence of postoperative dysphagia after anterior cervical spine surgery. Spine (Phila Pa 1976) 37(15):1292–1296
Ratnaraj J (2002) Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg 97(2 Suppl):176–179
Burkus JK (2016) Clinical and radiographic outcomes in patients undergoing single-level anterior cervical arthrodesis: a prospective trial comparing allograft to a reduced dose of rhBMP-2. Clin Spine Surg 30(9):E1321–E1332
Cole T (2014) Usage of recombinant human bone morphogenetic protein in cervical spine procedures: analysis of the MarketScan longitudinal database. J Bone Joint Surg Am 96(17):1409–1416
Jain A (2014) rhBMP use in cervical spine surgery: associated factors and in-hospital complications. J Bone Joint Surg Am 96(8):617–623
Liu Y (2016) Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy. Eur Spine J 25(6):1881–1890
Yin M (2016) The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate: a systematic review and meta-analysis. BMC Musculoskelet Disord 17(1):430
Xiao S (2016) Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion. Eur Spine J 26(4):975–984
Lee MJ (2005) Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 18(5):406–409
Pattavilakom A, Seex KA (2011) Results of a prospective randomized study comparing a novel retractor with a Caspar retractor in anterior cervical surgery. Neurosurgery 69(2 Suppl Operative):ons156–ons160 (discussion ons160)
Tian W, Yu J (2016) The role of C2–C7 angle in the development of dysphagia after anterior and posterior cervical spine surgery. Clin Spine Surg 28(2):131–138
Siska PA (2011) Dysphagia after anterior cervical spine surgery: a prospective study using the swallowing-quality of life questionnaire and analysis of patient comorbidities. Spine (Phila Pa 1976) 36(17):1387–1391
Suk KS (2006) Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 30(4):290–294
Kepler CK, Rihn JA, Bennett JD (2012) Dysphagia and softtissue swelling after anterior cervical surgery: a radiographic analysis. Spine J 12(8):639–644
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg 85:1–3
Jeyamohan SB (2015) Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial. J Neurosurg Spine 23(2):137–143
Lee SH (2011) Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study. Spine (Phila Pa 1976) 36(26):2286–2292
Edwards CC (2016) Can dysphagia following anterior cervical fusions with rhBMP-2 be reduced with local depomedrol application?: A prospective, randomized, placebo-controlled, double-blind trial. Spine (Phila Pa 1976) 41(7):555–562
Song KJ, Lee SK, Ko JH (2014) The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis. Spine J 14(12):2954–2958
Nam TW (2013) Effect of intravenous dexamethasone on prevertebral soft tissue swelling after anterior cervical discectomy and fusion. Acta Orthop Belg 79(2):211–215
Pedram M (2003) Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone. Eur Spine J 12(1):84–90
Lu DC, Tumialan LM, Chou D (2013) Multilevel anterior cervical discectomy and fusion with and without rhBMP-2: a comparison of dysphagia rates and outcomes in 150 patients. J Neurosurg Spine 18(1):43–49
Vaidya R (2007) Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2. Eur Spine J 16(8):1257–1265
Visocchi M, Della Pepa GM, Doglietto F, Esposito G, La Rocca G, Massimi L (2011) Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood. Childs Nerv Syst 27(5):825–831
Visocchi M, Doglietto F, Della Pepa GM, Esposito G, La Rocca G, Di Rocco C, Maira G, Fernandez E (2011) Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. Eur Spine J 20(9):1518–1525
Visocchi M, Di Martino A, Maugeri R, González Valcárcel I, Grasso V, Paludetti G (2015) Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J 24(12):2713–2723
Genovese O, Tosi F, Piastra M, Chiaretti A, Conti G, Di Rocco C, Visocchi M (2014) Anaesthesiological and intensive care management in craniovertebral junction surgery. Adv Tech Stand Neurosurg 40:171–197
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We do not have a financial or personal relationship with a third party. On behalf of all authors, the corresponding author states that there is no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Liu, J., Zhang, Y., Hai, Y. et al. Intravenous and local steroid use in the management of dysphagia after anterior cervical spine surgery: a systematic review of prospective randomized controlled trails (RCTs). Eur Spine J 28, 308–316 (2019). https://doi.org/10.1007/s00586-018-5840-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5840-5