Does Local Steroid Reduce Dysphagia After Cervical Disc Replacement? A Prospective, Randomized, Placebo-controlled, Double-blinded Study

Abstract

Study design: A prospective, randomized, placebo-controlled, double-blinded study.

Objective: To examine the effect of intraoperatively administered local Depo-Medrol on the incidence and severity of postoperative dysphagia in patients undergoing cervical disk replacement (CDR) surgery.

Summary of background data: Dysphagia is often reported as an adverse event after anterior cervical surgeries. One method for reducing the incidence of postoperative dysphagia in patients undergoing anterior cervical discectomy and fusion surgeries is the intraoperative application of topical corticosteroids to the retroesophageal space. There have been no studies examining the effect of local steroids on dysphagia after CDR surgery.

Materials and methods: Seventy-three patients underwent CDR surgery by a single surgeon at a single institution. A 1 cm ×3 cm ×3 mm gel foam collagen sponge was saturated by the nurse with either saline (1 cc) or Depo-Medrol (40 mg/1 cc) based on randomization protocol. The sponge was placed ventral to the cervical disk implant in the retroesophageal space. Study follow-up occurred on postoperative day 1, 4, 7, 14 and postoperative month 1, 2, and 3. Dysphagia outcomes were classified using the Bazaz Dysphagia Score and Eating Assessment Tool 10.

Results: The steroid group, compared with the control group, had significantly reduced incidence of dysphagia (50% vs. 75%; P=0.0427) and severe dysphagia (12% vs. 36% Bazaz score, P=0.0253; 18% vs. 42% Eating Assessment Tool 10, P=0.0378) at POD4. There was no significant long-term difference in rates of dysphagia between the control and the steroid group.

Conclusions: This study provides level 1 evidence that the use of intraoperative locally administered Depo-Medrol significantly reduces the incidence and severity of dysphagia within the first week after CDR surgery. The use of local steroid may provide patients undergoing CDR surgery with a more pleasant early recovery experience with respect to dysphagia.