General Session: Cervical Degenerative - Hall F

Presented by: B. Haws

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), D. Bohl(1), K. Cardinal(1), J. Guntin(1), K. Singh(1)

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

Abstract

Object: Intraoperative local steroid application has been theorized to reduce swelling and 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.

Methods: A prospective, randomized, single-blinded controlled trial was conducted. A priori power analysis determined that 104 subjects were needed to detect an 8 point difference in Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire score. A total of 104 patients undergoing 1-3 level ACDF procedures for degenerative spinal pathology were randomized to depomedrol (DEPO) or no depomedrol (NODEPO) cohorts. Prior to surgical closure, patients either received 1cc depomedrol (DEPO) or saline (NODEPO) applied to a gel-foam carrier at the surgical site. Patients were blinded to the application of steroid or saline following surgery. The SWAL-QOL questionnaire was administered both pre- and post-operatively. Using preoperative and postoperative lateral radiographs, a ratio of the prevertebral swelling distance to the anterior posterior (AP) diameter of each vertebral body level was calculated at the involved levels ± 1 level. The ratios of all levels were averaged and multiplied by 100 to obtain a swelling index. An air index was created using the same methodology, instead using tracheal air window diameter in place of prevertebral swelling distance. Statistical analysis was performed using student's t-test and chi-square analysis.

Results: Of the 104 patients, 55 patients (52.9%) were randomized to the DEPO cohort while 49 patients (47.1%) were randomized to the NODEPO group. There was no difference in the mean change in scaled total SWAL-QOL score, swelling index and air index between groups at any time point. Furthermore, there were no complications observed in either group (retropharyngeal abscess or esophageal perforation).

Conclusions: The results of this prospective, randomized, single blinded study do not demonstrate an impact of local intraoperative steroid application on patient-reported swallowing function or postoperative swelling following an ACDF. Administration of DEPO also did not lead to an earlier hospital discharge compared to the NODEPO cohort. These results suggest that local intraoperative steroid administration may not provide an additional benefit to patients undergoing ACDF procedures.

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