General Session: Cervical Degenerative

Presented by: A. Patel - View Audio/Video Presentation (Members Only)

Author(s):

T.J. Jenkins(1), B. Rosenthal(1), A. Ranade(2), W.K. Hsu(1), A.A. Patel(1)

(1) Northwestern University Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, IL, United States
(2) Rosalind Franklin University of Medicine and Science, Chicago, IL, United States

Abstract

Intro: Dysphagia and dysphonia are the most common complications following anterior cervical discectomy and fusion (ACDF). Fortunately, most post-ACDF dysphagia is mild and transient, but in the limited number of patients that develop severe dysphagia it will have profound effects on overall health and surgical outcomes. Severe dysphagia places the patient at higher risk for dehydration, malnutrition, social isolation, aspiration, pneumonia, and death. Previous studies have demonstrated that intravenous (IV) and local steroids can decrease prevertebral soft-tissue swelling, however, no standardized studies have compared the efficacy of local steroid application to controls during ACDF on post-operative dysphagia and dysphonia. We conducted a prospective randomized clinical trial to assess the efficacy of intra-operative steroid administration (intravenous or local) on dysphagia and dysphonia after ACDF.

Methods: 72 patients undergoing ACDF for the treatment of cervical degenerative disease were recruited. Inclusion criteria were patients greater than 18 years undergoing ACDF for the treatment of radiculopathy or myelopathy. Exclusion criteria included: age under 18 years, operations for trauma/infection/tumor/revision, or general metabolic diseases (diabetes, heart disease, renal disease). Patients were randomized into three cohorts: control (no steroid), IV steroid (10 mg one-time intraoperative dose of IV dexamethasone), or local steroid groups (40mg of triamcinolone placed in the retropharyngeal space directly on the cervical plate). Subjects were blinded from which treatment arm they received. Primary outcomes were measured for dysphagia (Bazaz, Eat-10) and dysphonia (VHI-10). Secondary outcomes include Neck Disability Index (NDI) and Visual Analog Scale (VAS) for neck pain. Patient outcomes were collected pre-operatively, post-operative day 1, week 2, and week 6. Statistical analysis was completed with significance set at p < 0.05.

Results: Baseline patient reported outcomes for dysphagia, dysphonia, and neck pain were not significantly different between the groups. Day 1 post-operative patient outcomes scores showed a significant improvement in dysphonia (VHI-10 p=0.026) and neck pain (VAS:neck pain p=0.025) in the local steroid group. There was also a trend towards significant improvement of post-operative Day 1 dysphagia with the local steroid group (Bazaz p=0.057). The local steroid cohort showed significant improvement in dysphagia (Bazaz p=0.026; Eat-10 p=0.011) and neck pain (p=0.042) at 2 weeks post-operative when compared to the other treatment groups. At 6 weeks post-operative the local group had significantly less severe dysphagia (Bazaz p=0.001; Eat-10 p< 0.001) when compared to the other treatment groups.

Conclusion: Local steroid application at the conclusion of cervical plating in ACDF surgery yields better patient-reported outcomes for dysphagia, dysphonia, and neck pain, when compared to no steroid or IV steroid administration.