Administering topical steroids during anterior cervical discectomy and fusion (ACDF) surgery helps reduce swallowing difficulties following the procedure, according to a Hospital for Special Surgery study.

The study, published in The Spine Journal, is available online as part of the AAOS 2020 Virtual Education Experience.

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. 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.”

— Todd Albert, MD, lead investigator and surgeon-in-chief emeritus at HSS

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, a media release from Hospital for Special Surgery explains.

“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,” Albert adds.

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 note, in the release. “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, the release concludes.

[Source(s): Hospital for Special Surgery, Newswise]

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