The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis |
| |
| Authors: | Kyung-Jin Song Su-Kyung Lee Jong-Hyun Ko Myung-Jae Yoo Do-Yeon Kim Kwang-Bok Lee |
| |
| Institution: | 1. Department of Neurosurgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands;2. Department of Radiology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA The Hague, The Netherlands;3. Department of Medical Decision Making, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands;4. Department of General Practice, Erasmus Medical Center, University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands;5. Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA The Hague, The Netherlands;1. Grand Rapids Medical Education Partners, 1000 Monroe Ave NW, Grand Rapids, MI 48195, USA;2. Department of Surgery, BG-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany;3. Department of Orthopaedic Surgery, Orthopaedic Associates of Michigan, Michigan State University, 230 Michigan St NE, Suite 300, Grand Rapids, MI 49503, USA;4. Department of Surgery, Michigan State University, Grand Rapids, 230 Michigan St NE, Suite 300, MI 49503, USA;1. Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario de Elche, Elche, Alicante, Spain;2. Departamento de Neurocirugía, Hospital General Universitario de Elche, Elche, Alicante, Spain;3. Departamento de Ciencias de la Salud, Universidad Jaume I de Castellón, Castellón de la Plana, Spain;1. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA;2. Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL 60064, USA;3. Department of Surgery, Vascular Surgery Division, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;4. Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA;1. Royal North Shore Hospital, St Leonards, New South Wales, Australia;2. Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Prince of Wales Hospital, Sydney, New South Wales, Australia;1. Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States;2. Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States |
| |
| Abstract: | Background contextDysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF), and it is closely related to prevertebral soft-tissue swelling (PSTS). A few studies have found that local or systemic methylprednisolone is effective against laryngopharyngeal edema and airway obstruction.PurposeTo assess the effectiveness of short-term use of systemic methylprednisolone in relieving dysphagia and decreasing PSTS during the hospitalization period.Study designA prospective study.Patient sampleForty patients who underwent multilevel (more than three levels) ACDF with same plate fixation.Outcome measureRadiologic and clinical measures.MethodsTwenty of these patients were given 250 mg of methylprednisolone intravenously (IV) four times a day only for 24 hours after the operation (at 6-hour intervals), whereas the remaining 20 did not receive methylprednisolone and served as controls. We used the Bazaz scale to compare the degree of dysphagia between groups during the hospitalization period. We used the C-spine lateral view to assess the degree of pre- and postoperative PSTS from C2 to C7. At the final follow-up, we assessed the relationship between the occurrence of complications and steroid use.ResultsThe degree of dysphagia according to the Bazaz scale was less severe in the group that received methylprednisolone (p values; postoperative Day POD] 2～5<.05, POD 6=.014, POD 7=.019). Prevertebral soft-tissue swelling was also significantly lower in the group that received methylprednisolone (p values; POD 2～POD 5 <.005, POD 1=.061, POD 6=.007, POD 7=.091). The amount of PSTS and dysphagia did not differ according to sex, age, smoking history, or length of surgery. The period of hospitalization in the experimental group was shorter than in the control group. No complications related to steroid use were found at the final follow-up.ConclusionsThe short-term use of systemic methylprednisolone after ACDF appears to be effective in relieving dysphagia and decreasing the PSTS. Furthermore, the short-term use of methylprednisolone was not associated with any adverse effects of short-term IV steroid usage, such as peptic ulcer disease or postoperative infection. The clinical use of methylprednisolone in relieving dysphagia and decreasing PSTS deserves consideration during the early postoperative period. |
| |
| Keywords: | Anterior cervical discectomy and fusion (ACDF) Methylprednisolone Dysphagia Prevertebral soft-tissue swelling (PSTS) Adverse effects Short-term IV usage |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
