Perioperative steroids may reduce dysphagia after anterior cervical surgery

SAN DIEGO — Patients who undergo anterior cervical surgery for fusion, corpectomy or total disc replacement may benefit from perioperative treatment with steroids to reduce the symptoms of dysphagia after surgery, based on findings from a recently presented randomized, prospective, double-blind study.

Dysphagia is a common perioperative complication following anterior cervical surgery, according to Sanford E. Emery, MD, MBA, who presented data at the Cervical Spine Research Society Annual Meeting, here, that showed patients who received steroid intravenous (IV) treatments immediately prior to incision had a statistically significant reduction of dysphagia symptoms. This reduction was seen at all time points compared with patients who received perioperative IV saline treatment.

These improvements, however, did not provide a long-term solution, Emery said.

Steroids vs saline

“With the results of our trial and other recent well-designed studies, it appears perioperative intravenous steroids can successfully decrease dysphagia symptoms after anterior cervical spine surgery,” Emery told Spine Surgery Today.

The research study was funded by the Cervical Spine Research Society 21st Century Research and Education grant.

Emery and colleagues administered the steroid Decadron (dexamethasone, Merck Sharp & Dohme) intravenously to 33 patients and administered saline intravenously to 31 patients just prior to incision. Neither the patients nor the surgeons knew who received the steroids or saline.

The steroid dose per kilogram was 0.3 mg for the first dose, then 0.15 mg each for the next two doses. For the average-size-person, this is about 20 mg, 10 mg and 10 mg. The three doses were given over 24 hours, according to Emery.

Surveys for dysphagia symptoms

The investigators assessed swallowing function with the Dysphagia Short Questionnaire and Bazaz scale. Patients were given the surveys preoperatively and then at eight time points postoperatively until 1 year. To assess pain, investigators used the QoL-12, Neck Disability Index (NDI) and VAS scores to evaluate the patients preoperatively and at 1-month, 3-months, 6-months and 12-months postoperatively.

Emery said 49 patients underwent anterior cervical discectomy and fusion (ACDF), nine patients underwent a corpectomy and six patients underwent a disc arthroplasty procedure. Nearly equal numbers of patient underwent one-level and multi-level procedures, he said.

The randomization did its job as the investigators identified no preoperative differences in age, gender, number of levels operated, smoking status, anesthesia type, BMI and clinical outcomes between the saline and steroid groups, according to Emery

“Our results from the questionnaires show the steroid group had less dysphagia on average over all time points vs. the saline group. It was highly statistically different, a P value of less than 0.0001,” Emery said during his presentation.

Steroids improved dysphagia

The dysphagia improvement in the steroid group became most evident at two weeks postoperative, but the improvements did not last through the 1-year follow-up, Emery noted.

Furthermore, the steroids had no effect on quality of life measures, such as the physical component scores, mental component scores and NDI scores, at any time point.

“[The] most benefit from steroids was at the first 2 weeks and it was gone by a year. There were no early postoperative negative effects, no infections, anything like that, but our fusion data are still pending. It also did not affect the quality of life measures. These people can still go out, mow their lawn, go hunting or go to the refrigerator and still enjoy that,” Emery said at the meeting.

He noted that data for the steroid cohort trended toward a decreased length of hospital stay, but did not reach statistical significance.

Emery concluded the data from this study support the use of perioperative steroids to decrease the symptoms of dysphagia up to several months postoperatively in patients who undergo anterior cervical surgery. – by Robert Linnehan

Reference:
Emery SE, et al. The effects of perioperative steroids on dysphagia following anterior cervical spine surgery: A randomized, prospective, double-blind study. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 3-5, 2015; San Diego.

For more information:

Sanford E. Emery, MD, MBA, can be reached at Department of Orthopaedics, West Virginia University School of Medicine, 1 Stadium Dr., Morgantown, WV 26505; email: semery@hsc.wvu.edu.

Disclosure: Emery reports he serves on the boards of the American Board of Orthopaedic Surgery and the American Orthopaedic Association.