Study: Topical Steroids Administered During Cervical Spine Surgery Reduce Swallowing Difficulties After the Procedure

A study from Hospital for Special Surgery (HSS) finds that topical steroids administered during anterior cervical discectomy and fusion (ACDF) surgery help reduce swallowing difficulties following the procedure. This study is available online as part of the AAOS 2020 Virtual Education Experience. The results were also published in The Spine Journal in September 2019.

ACDF is performed to relieve a painful condition of the cervical spine, or neck, when conservative treatments such as medication and physical therapy fail to help patients. A small incision is made in the throat to remove a ruptured or worn-out disc. After the surgeon removes the damaged disc, the bones are fused together.

“Although ACDF is a popular approach with a high success rate, one of the more common complications is the development of post-operative dysphagia, which is trouble swallowing,” said Todd Albert, MD, lead investigator and surgeon-in-chief emeritus at HSS. “The severity of dysphagia experienced by patients following ACDFs can range from a mild and subjective discomfort such as fullness of the throat and soreness to a serious medical issue such as malnutrition, social isolation, aspiration pneumonia or airway obstruction. Many studies show that most dysphagia-related symptoms occur in the early phase of the recovery period and gradually dissipate over time.”

Dr. Albert and colleagues launched the study to determine if administering topical steroids behind the esophagus during surgery could reduce the swallowing problems some patients experience after the procedure. Patients scheduled for multilevel ACDF surgery were enrolled and randomized into two groups in a double-blind fashion. The steroid group received 40 mg of methylprednisolone delivered in an absorbable gel matrix prior to the completion of surgery. The control group received the absorbable gel without the steroid.

“To reduce any possible bias associated with the study, our hypothesis was that there would be no difference in swallowing difficulty between the patients who receive intraoperative topical steroids and those who do not receive the steroids,” Dr. Albert noted.

Ninety-five patients were included in the final analysis; 48 received the steroid and 47 were in the control group. The mean age was 57 years old, and 52 percent of patients were male. Comparison of the two groups revealed no significant differences in demographics, diagnosis, number of levels fused in the cervical spine or time necessary to perform the surgery.

After the procedure, patients in both groups completed validated questionnaires to evaluate their ability to eat and swallow. The analysis revealed that the group receiving the steroids had significantly better dysphagia scores than the control group.

“Our study demonstrated the benefit of intraoperative steroids with this delivery method to prophylactically reduce swallowing difficulty following ACDF surgery,” the researchers noted. “The early post-operative results were superior for the group who received the topical steroids, especially at two days following surgery, and maintained at one month.” Investigators are planning a future study to evaluate long-term outcomes when steroids are used in ACDF surgery.

Disclosures: Dr. Albert has no disclosures relevant to this study.

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the tenth consecutive year), No. 3 in rheumatology by U.S. News & World Report (2019-2020), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2019-2020). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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