AAOS2017: Local steroid following ACDF lowers incidence of dysphagia postoperatively

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
72 patients undergoing anterior cervical discectomy and fusion (ACDF) were included in this study to determine the effects of different steroid treatments on postoperative dysphagia and dysphonia. Patients were randomized to three groups: a control group receiving no steroid, an intravenous (IV) steroid group receiving 10mg of dexamethasone intraoperatively, or a local steroid group receiving 40mg of triamcinolone in the retropharyngeal space directly on the cervical plate. At 2 weeks, Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Two of the most common complications following anterior cervical discectomy and fusion (ACDF) are dysphagia and dysphonia. While these complications are often mild and transient, some cases are severe and can have detrimental effects on the overall health of patients. Several studies have indicated that local steroids can reduce prevertebral soft tissue swelling following ACDF, but none have evaluated the effect of local steroid injections on dysphagia and dysphonia compared to a control.
What was the principal research question?
Following anterior cervical discectomy and fusion, does local or intravenous steroid administration have any significant effect on outcome measures related to dysphagia and dysphonia in comparison to no steroid when assessed over the first 6 weeks postoperatively?
Population: 72 patients, over the age of 18 years, with cervical degenerative disc disease and scheduled for anterior cervical discectomy and fusion.
Intervention: IV steroid group: Patients received a single intraoperative dose of 10mg intravenous dexamethasone. (n=25) Local steroid group: Patients received 40mg of triamcinolone in the retropharyngeal space directly on the cervical plate. (n=29)
Comparison: Control group: Patients did not receive steroid administration (n=19)
Outcomes: The primary outcomes were dysphagia (Bazaz, Eat-10) and dysphonia (VHI-10). Secondary outcomes included Neck Disability Index (NDI) and pain on a visual analgoue scale (VAS).
Methods: RCT: Patient-blinded
Time: Outcomes were assessed on day 1, week 2, and week 6
What were the important findings?
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How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.