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The retropharyngeal steroid use during operation on the fusion rate and dysphagia after ACDF? A systematic review and meta-analysis

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Abstract

Purpose

The aim of this meta-analysis was to investigate the effects of retropharyngeal steroid use during operation on bony fusion and dysphagia rate after ACDF.

Methods

We searched the electronic literature database of PubMed, Embase and the Cochrane Library published from January 1990 to February 2020. The size of each group, mean age, proportion of female patients, dysphagia events and fusion rate at one-year follow-up were extracted. RevMan 5.3 was used for the meta-analysis.

Results

A total of eight studies including six RCTs and two case–control studies met the inclusion criteria. This meta-analysis showed that retropharyngeal steroids could achieve significantly lower dysphagia rates (p < 0.001), higher fusion rates (p = 0.01), less moderate and severe events rates according to the Bazaz stratification (p < 0.001). However, there was no significant difference between two groups regarding operation time (p = 0.67), blood loss (p = 0.33), VAS scores at one day (p = 0.90) and VAS scores at two weeks (p = 0.80).

Conclusions

Retropharyngeal steroid use is an effective method in reducing dysphagia rate, severe dysphagia rate and increasing fusion rate during ACDF surgery, without increasing operating time, blood loss or VAS scores at one day and two weeks.

Level of Evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

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Availability of data and materials

The data analyzed during the current meta-analysis are available from the corresponding author on reasonable request.

Abbreviations

ACDF:

Anterior cervical discectomy and fusion

PEEK:

Polyetheretherketone

NOS:

Newcastle–Ottawa scale

SD:

Standard deviation

VAS:

Visual analog scale

References

  1. Saifi C, Fein AW, Cazzulino A, Lehman RA, Phillips FM, An HS, Riew KD (2018) Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J 18(6):1022–1029. https://doi.org/10.1016/j.spinee.2017.10.072

    Article  PubMed  Google Scholar 

  2. Epstein NE (2019) A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int 10:100. https://doi.org/10.25259/SNI-191-2019

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cho SK, Lu Y, Lee DH (2013) Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J. 95B(7):868–873. https://doi.org/10.1302/0301-620X.95B7.31029

    Article  Google Scholar 

  4. Andrew SA, Sidhu KS (2007) Airway changes after anterior cervical discectomy and fusion. J Spinal Disord Tech 20(8):577–581. https://doi.org/10.1097/BSD.0b013e3180421bfb

    Article  PubMed  Google Scholar 

  5. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr (2007) Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32(21):2310–2317. https://doi.org/10.1097/BRS.0b013e318154c57e

    Article  Google Scholar 

  6. Grasso G, Leone L, Torregrossa F (2019) Dysphagia prevention in anterior cervical discectomy surgery: results from a prospective clinical study. World Neurosurg 125:e1176–e1182. https://doi.org/10.1016/j.wneu.2019.01.273

    Article  PubMed  Google Scholar 

  7. Jenkins TJ, Nair R, Bhatt S, Rosenthal BD, Savage JW, Hsu WK, Patel AA (2018) The effect of local versus intravenous corticosteroids on the likelihood of dysphagia and dysphonia following anterior cervical discectomy and fusion a single-blinded, prospective, randomized controlled trial. J Bone Joint Surg Am 100(17):1461–1472. https://doi.org/10.2106/JBJS.17.01540

    Article  PubMed  Google Scholar 

  8. Song KJ, Lee SK, Ko JH, Yoo MJ, Kim DY, Lee KB (2014) The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis. Spine J 14(12):2954–2958. https://doi.org/10.1016/j.spinee.2014.06.005

    Article  PubMed  Google Scholar 

  9. Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, Le Roux PD (2002) Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 15(5):362–368. https://doi.org/10.1097/00024720-200210000-00004

    Article  PubMed  Google Scholar 

  10. Saville P, Vaishnav AS, McAnany S, Gang CH, Qureshi SA (2018) Predictive factors of post-operative dysphagia in single-level anterior cervical discectomy and fusion (ACDF). Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002865

    Article  Google Scholar 

  11. van Eck CF, Regan C, Donaldson WF, Kang JD, Lee JY (2014) The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients. Spine (Phila Pa 1976) 39(26):2143–2147. https://doi.org/10.1097/BRS.0000000000000636

    Article  Google Scholar 

  12. Chen Z, Wei X, Li F, He P, Huang X, Zhang F, Qi K, Liu X, Shen H, Hou T, Riew KD (2012) Tracheal traction exercise reduces the occurrence of postoperative dysphagia after anterior cervical spine surgery. Spine (Phila Pa 1976) 37(15):1292–1296. https://doi.org/10.1097/BRS.0b013e3182477f26

    Article  Google Scholar 

  13. Burkus JK, Dryer RF, Arnold PM, Foley KT (2017) Clinical and radiographic outcomes in patients undergoing single-level anterior cervical arthrodesis: a prospective trial comparing allograft to a reduced dose of rhBMP-2. Clin Spine Surg 30(9):E1321–E1332. https://doi.org/10.1097/BSD.0000000000000409

    Article  PubMed  Google Scholar 

  14. Jain A, Hassanzadeh H, Strike SA, Skolasky RL, Riley LH 3rd (2014) rhBMP use in cervical spine surgery: associated factors and in-hospital complications. J Bone Joint Surg Am 96(8):617–623. https://doi.org/10.2106/JBJS.M.00666

    Article  PubMed  Google Scholar 

  15. Xiao S, Liang Z, Wei W, Ning J (2017) Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion. Eur Spine J 26(4):975–984. https://doi.org/10.1007/s00586-016-4914-5

    Article  PubMed  Google Scholar 

  16. Pattavilakom A, Seex KA (2011) Results of a prospective randomized study comparing a novel retractor with a Caspar retractor in anterior cervical surgery. Neurosurgery 69(2):ons156-160. https://doi.org/10.1227/NEU.0b013e318219565f

    Article  PubMed  Google Scholar 

  17. Harada GK, Alter K, Nguyen AQ, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D (2020) Cervical spine endplate abnormalities and association with pain disability and adjacent segment degeneration after anterior cervical discectomy and fusion. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000003460

    Article  Google Scholar 

  18. Lee HC, Chen CH, Wu CY, Guo JH, Chen YS (2019) Comparison of radiological outcomes and complications between single-level and multilevel anterior cervical discectomy and fusion (ACDF) by using a polyetheretherketone (PEEK) cage-plate fusion system. Medicine (Baltimore) 98(5):e14277. https://doi.org/10.1097/MD.0000000000014277

    Article  CAS  Google Scholar 

  19. Siasios I, Fountas K, Dimopoulos V, Pollina J (2018) The role of steroid administration in the management of dysphagia in anterior cervical procedures. Neurosurg Rev 41(1):47–53. https://doi.org/10.1007/s10143-016-0741-8

    Article  PubMed  Google Scholar 

  20. Adenikinju AS, Halani SH, Rindler RS, Gary MF, Michael KW, Ahmad FU (2017) Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: a systematic review. Int J Spine Surg 11:9. https://doi.org/10.14444/4009

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen CJ, Saulle D, Fu KM, Smith JS, Shaffrey CI (2013) Dysphagia following combined anterior-posterior cervical spine surgeries. J Neurosurg Spine 19(3):279–287. https://doi.org/10.3171/2013.6.SPINE121134

    Article  PubMed  Google Scholar 

  22. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, Montori V, Akl EA, Djulbegovic B, Falck-Ytter Y, Norris SL, Williams JW Jr, Atkins D, Meerpohl J, Schunemann HJ (2011) GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol 64(4):407–415. https://doi.org/10.1016/j.jclinepi.2010.07.017

    Article  PubMed  Google Scholar 

  23. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  24. Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N (2006) Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol 59(1):7–10. https://doi.org/10.1016/j.jclinepi.2005.06.006

    Article  PubMed  Google Scholar 

  25. Jeyamohan SB, Kenning TJ, Petronis KA, Feustel PJ, Drazin D, DiRisio DJ (2015) Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial. J Neurosurg Spine 23(2):137–143. https://doi.org/10.3171/2014.12.SPINE14477

    Article  PubMed  Google Scholar 

  26. Koreckij TD, Davidson AA, Baker KC, Park DK (2016) Retropharyngeal steroids and dysphagia following multilevel anterior cervical surgery (Phila Pa 1976). Spine 41(9):E530-534. https://doi.org/10.1097/BRS.0000000000001293

    Article  PubMed  Google Scholar 

  27. Cui S, Daffner SD, France JC, Emery SE (2019) The effects of perioperative corticosteroids on dysphagia following surgical procedures involving the anterior cervical spine: a prospective, randomized, controlled, double-blinded clinical trial. J Bone Joint Surg Am 101(22):2007–2014. https://doi.org/10.2106/JBJS.19.00198

    Article  PubMed  Google Scholar 

  28. Gandhi SD, Wahlmeier ST, Louie P, Sauber R, Tooley TR, Baker KC, Park DK (2020) Effect of local retropharyngeal steroids on fusion rate after anterior cervical discectomy and fusion. Spine J 20(2):261–265. https://doi.org/10.1016/j.spinee.2019.08.018

    Article  PubMed  Google Scholar 

  29. Lee SH, Kim KT, Suk KS, Park KJ, Oh KI (2011) Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion; a prospective, randomized study. Spine. https://doi.org/10.1097/BRS.0b013e318237e5d0

    Article  PubMed  PubMed Central  Google Scholar 

  30. Haws BE, Khechen B, Narain AS, Hijji FY, Bohl DD, Massel DH, Mayo BC, Ahn J, Singh K (2018) Impact of local steroid application on dysphagia following an anterior cervical discectomy and fusion: results of a prospective, randomized single-blind trial. J Neurosurg Spine 29(1):10–17. https://doi.org/10.3171/2017.11.SPINE17819

    Article  PubMed  Google Scholar 

  31. Lee SH, Mesfin A, Riew KD (2015) Delayed esophageal perforation after anterior cervical fusion and retropharyngeal steroid use: a report of two cases. Spine J 15(10):e75-80. https://doi.org/10.1016/j.spinee.2015.06.058

    Article  PubMed  Google Scholar 

  32. Ramos-Zuniga R, Saldana-Koppel DA (2016) Letter to the editor: reduction of early postoperative dysphagia via steroid use after anterior cervical surgery. J Neurosurg Spine 24(6):1000. https://doi.org/10.3171/2015.9.SPINE151162

    Article  PubMed  Google Scholar 

  33. Liu J, Zhang Y, Hai Y, Kang N, Han B (2019) Intravenous and local steroid use in the management of dysphagia after anterior cervical spine surgery: a systematic review of prospective randomized controlled trails (RCTs). Eur Spine J 28(2):308–316. https://doi.org/10.1007/s00586-018-5840-5

    Article  PubMed  Google Scholar 

  34. Robinson WA, Carlson BC, Freedman BA, Sebastian AS (2019) Retropharyngeal steroid use in anterior cervical discectomy and fusion. Clin Spine Surg 32(1):1–3. https://doi.org/10.1097/BSD.0000000000000653

    Article  PubMed  Google Scholar 

  35. Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE (2003) Pseudoarthrosis of the cervical spine a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976) 28(1):46–51. https://doi.org/10.1097/00007632-200301010-00012

    Article  Google Scholar 

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Authors and Affiliations

  1. Graduate School of Peking, Union Medical College, Beijing, People’s Republic of China

    Jipeng Song, Long Gong & Mingsheng Tan

  2. Department of Spinal Surgery, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, 100029, People’s Republic of China

    Jipeng Song, Ping Yi, Yanlei Wang, Long Gong, Yan Sun, Feng Yang, Xiangsheng Tang & Mingsheng Tan

  3. Graduate School of Beijing University of Chinese Medicine, Beijing, People’s Republic of China

    Yanlei Wang & Yan Sun

  4. Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China

    Jipeng Song

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Contributions

MST and PY developed the protocol and involved in the design, selection of study, data extraction, and statistical analysis and developing the initial drafts of the manuscript. FY, LG, YS and XST involved in data extraction, quality assessment, statistical analysis and revising. JPS and YLW prepared the final draft of the manuscript. All authors read and approved the final draft of the manuscript.

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Correspondence to Mingsheng Tan.

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Song, J., Yi, P., Wang, Y. et al. The retropharyngeal steroid use during operation on the fusion rate and dysphagia after ACDF? A systematic review and meta-analysis. Eur Spine J 31, 288–300 (2022). https://doi.org/10.1007/s00586-021-06727-1

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