General Session: Cervical Motion Preservation

Presented by: K. Yom - View Audio/Video Presentation (Members Only)

Author(s):

D. Massel(1), B. Mayo(1), J. Ahn(1), D. Bohl(1), F. Hijji(1), A. Narain(1), K. Yom(1), K. Kudaravalli(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Intraoperative local steroid application has been theorized to reduce swelling and to improve swallowing in the immediate postoperative period following an anterior cervical discectomy and fusion (ACDF). As such, the purpose of this study is to quantify the impact of intraoperative local steroid application on patient-reported swallow function and postoperative swelling following an ACDF.

Materials and Methods: Total of 56 patients undergoing a 1- or 2-level ACDF were randomized to depomedrol (DEPO) or no depomedrol (NODEPO) cohorts, receiving 1cc depomedrol or 1cc saline, respectively, applied to the surgical site using a gel-foam carrier (retroesophageal). The results of the SWAL-QOL questionnaire were compared between cohorts. Using pre- and postoperative lateral radiographs, a ratio of the prevertebral swelling distance to the anterior-posterior diameter of each vertebral body level was calculated for the index level (operative level), 2 vertebral levels above and below to obtain a swelling index. Similarly, the air index was calculated using the tracheal air window diameter. Any changes in these ratios (preoperative, 1-day, 6-weeks, and 12-weeks postoperatively) were compared between cohorts.

Results: Of the 56 patients, 32 patients (57.1%) and 24 patients (42.9%) were randomized to the DEPO and NODEPO groups, respectively. The DEPO cohort demonstrated a higher percentage of smokers (15.6% vs 0.0%; p=0.042). There were no differences in patient demographics, preoperative characteristics, or the mean change in scaled total SWAL-QOL score between the DEPO and NODEPO patients at any postoperative time point (6-weeks: p=0.505; 12 weeks: p=0.487). Lastly, the mean change in both swelling and air indices were no different between cohorts.

Conclusions: The preliminary results of this prospective, randomized, single blinded study do not demonstrate a significant impact of local intraoperative steroid application on patient-reported swallowing function or postoperative swelling following an ACDF. Both cohorts exhibit an increase in radiographic swelling in the immediate postoperative period, which subsides to near normal levels by 12-weeks postoperatively. Administration of DEPO also did not lead to an earlier hospital discharge compared to the NODEPO cohort. Additionally, patient reported swallowing scores did not correlate with changes in radiographic swelling or airway diameter. Enrollment of additional patients is ongoing and will help determine the true impact of local intraoperative steroid application on patient-reported dysphagia.

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