The effect of local intraoperative corticosteroid application on postoperative dysphagia following anterior cervical spine surgery

Abstract

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local corticosteroid application on dysphagia, its safety and efficacy are still unclear. A systematic review was performed aiming to evaluate the evidence of local corticosteroid application in prevention or treatment of postoperative dysphagia following ACSS. A systematic search was performed in September 2018 in PubMed and Embase database. The following information was extracted: study investigator, year of publication, number of patients, study design, inclusion/exclusion criteria, administration protocol of steroid, type of surgical procedure, number of levels performed, assessment methodology of dysphagia, radiologic assessment of prevertebral soft tissue swelling (PSTS), follow-up time points, outcome of dysphagia, and corticosteroid-related complications. Qualitative synthesis was performed. Finally, 5 studies met the inclusion/exclusion criteria. Four studies found that local corticosteroid application could decrease the incidence and magnitude of postoperative dysphagia while 1 study showed no effect on dysphagia significantly at 6 weeks and 3 months follow-up time. A total of 2325 patients received local corticosteroid intraoperatively; no early corticosteroid-related complication was reported. Totally, 4 adverse events occurred in long-term follow-up time, including 2 bone nonunion at 1.5 and 2.5 years postoperatively, 2 esophageal perforation at 2 months and 11 months of follow-up, respectively. Local corticosteroid application can reduce the incidence and severity of dysphagia following ACSS without increasing early corticosteroid-related complications. But further high-quality study is necessary to analyze potential delayed complications.

Appendix

PubMed search (10-9-2018): (((((((deglutition disorders[MeSH Terms]) OR dysphagia[Title/Abstract]) OR soft tissue[Text Word]) OR edema[Text Word]) OR swelling[Text Word])) AND (((((((((steroid[MeSH Terms]) OR glucocorticoid[MeSH Terms]) OR corticosteroid[Text Word]) OR methylprednisolone[MeSH Terms]) OR methylprednisolone acetate[Text Word]) OR hydrocortisone[MeSH Terms]) OR cortisone[MeSH Terms]) OR hydroxycorticosteroid[MeSH Terms]) OR hexadecadrol [Text Word])) AND (((((((((((((((total disc replacement[MeSH Terms]) OR disc replacement, total[Title/Abstract]) OR replacement, total disc[Title/Abstract]) OR disk replacement[Title/Abstract]) OR artificial disk replacement[Title/Abstract]) OR disk replacement, artificial[Title/Abstract]) OR disc replacement[Title/Abstract]) OR artificial disc[Title/Abstract]) OR arthrodesis[MeSH Terms]) OR fusion [Title/Abstract]) OR diskectomy[MeSH Terms]) OR discectomy[Title/Abstract]) OR corpectomy[Title/Abstract]) OR decompression[Title/Abstract]) OR degenerat*[Text Word])

Embase search (10-9-2018): (‘dysphagia’/exp OR ‘deglutition disorder’:ab,ti OR ‘soft tissue’:ab,ti OR ‘edema’:ab,ti OR ‘swelling’:ab,ti) AND (‘steroid’/exp OR ‘glucocorticoid’/exp OR ‘corticosteroid’/exp OR ‘methylprednisolone acetate’/exp OR ‘hydrocortisone’/exp OR ‘cortisone’/exp OR ‘hydroxycorticosteroid’/exp OR ‘hexadecadrol’:ab,ti) AND (‘total disc replacement’/exp OR ‘disc replacement, total’:ab,ti OR ‘replacement, total disc’:ab,ti OR ‘disk replacement’:ab,ti OR ‘artificial disk replacement’:ab,ti OR ‘disk replacement, artificial’:ab,ti OR ‘disc replacement’:ab,ti OR ‘discectomy’/exp OR ‘diskectomy’:ab,ti OR ‘corpectomy’:ab,ti OR ‘decompression’:ab,ti OR ‘degenerat*’:ab,ti)