Impact of local steroid application on dysphagia following an anterior cervical discectomy and fusion: results of a prospective, randomized single-blind trial

OBJECTIVEIntraoperative local steroid application has been theorized to reduce swelling and improve swallowing in the immediate period following anterior cervical discectomy and fusion (ACDF). Therefore, the purpose of this study was to quantify the impact of intraoperative local steroid application on patient-reported swallow function and swelling after ACDF.METHODSA prospective, randomized single-blind controlled trial was conducted. A priori power analysis determined that 104 subjects were needed to detect an 8-point difference in the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire score. One hundred four patients undergoing 1- to 3-level ACDF procedures for degenerative spinal pathology were randomized to Depo-Medrol (DEPO) or no Depo-Medrol (NODEPO) cohorts. Prior to surgical closure, patients received 1 ml of either Depo-Medrol (DEPO) or saline (NODEPO) applied to a Gelfoam carrier at the surgical site. Patients were blinded to the application of steroid or saline following surgery. The SWAL-QOL questionnaire was administered both pre- and postoperatively. A ratio of the prevertebral swelling distance to the anteroposterior diameter of each vertebral body level was calculated at the involved levels ± 1 level by using pre- and postoperative lateral radiographs. The ratios of all levels were averaged and multiplied by 100 to obtain a swelling index. An air index was calculated in the same manner but using the tracheal air window diameter in place of the prevertebral swelling distance. Statistical analysis was performed using the Student t-test and chi-square analysis. Statistical significance was set at p < 0.05.RESULTSOf the 104 patients, 55 (52.9%) were randomized to the DEPO cohort and 49 (47.1%) to the NODEPO group. No differences in baseline patient demographics or preoperative characteristics were demonstrated between the two cohorts. Similarly, estimated blood loss and length of hospitalization did not differ between the cohorts. Neither was there a difference in the mean change in the scaled total SWAL-QOL score, swelling index, and air index between the groups at any time point. Furthermore, no complications were observed in either group (retropharyngeal abscess or esophageal perforation).CONCLUSIONSThe results of this prospective, randomized single-blind study did not demonstrate an impact of local intraoperative steroid application on patient-reported swallowing function or swelling following ACDF. Neither did the administration of Depo-Medrol lead to an earlier hospital discharge than that in the NODEPO cohort. These results suggest that intraoperative local steroid administration may not provide an additional benefit to patients undergoing ACDF procedures.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: Class I.Clinical trial registration no.: NCT03311425 (clinicaltrials.gov)

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Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants

Neurosurgery ◽

10.1093/neuros/nyab079 ◽

2021 ◽

Author(s):

Won Hyung A Ryu ◽

Dominick Richards ◽

Mena G Kerolus ◽

Adewale A Bakare ◽

Ryan Khanna ◽

...

Keyword(s):

Smoking Status ◽

Posterior Instrumentation ◽

Patient Reported Outcome ◽

Anterior Cervical Discectomy ◽

Successful Outcome ◽

Cervical Discectomy ◽

Structural Allograft ◽

Modifiable Factors ◽

Patient Reported ◽

The Impact

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

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The Impact of Local Steroid Application on Dysphagia following an Anterior Cervical Discectomy and Fusion: Preliminary Results of a Prospectively, Randomized, Single Blind Trial

The Spine Journal ◽

10.1016/j.spinee.2016.07.116 ◽

2016 ◽

Vol 16 (10) ◽

pp. S205-S206

Author(s):

Dustin H. Massel ◽

Benjamin Mayo ◽

Junyoung Ahn ◽

Daniel D. Bohl ◽

Philip Louie ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Blind Trial ◽

Preliminary Results ◽

The Impact ◽

Single Blind ◽

Single Blind Trial

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A single blind randomised controlled trial of the impact on patient-reported pain of arm elevation versus exsanguination prior to tourniquet inflation

The Bone & Joint Journal ◽

10.1302/0301-620x.98b4.36014 ◽

2016 ◽

Vol 98-B (4) ◽

pp. 519-525 ◽

Cited By ~ 4

Author(s):

D. A. Lees ◽

J. B. Penny ◽

P. Baker

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Patient Reported ◽

Arm Elevation ◽

Randomised Controlled ◽

The Impact ◽

Single Blind ◽

Tourniquet Inflation

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Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04056-y ◽

2021 ◽

Author(s):

James S. Chambers ◽

Robert G. Kropp ◽

Raymond J. Gardocki

Keyword(s):

Patient Reported Outcomes ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Patient Reported ◽

Reoperation Rates

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Effect of Auricular Point Acupressure on Axial Neck Pain After Anterior Cervical Discectomy and Fusion: A Randomized Controlled Trial

Pain Medicine ◽

10.1093/pm/pnx112 ◽

2017 ◽

Vol 19 (1) ◽

pp. 193-201 ◽

Cited By ~ 2

Author(s):

Bingjiang Xia ◽

Yiping Xie ◽

Songfeng Hu ◽

Taotao Xu ◽

Peijian Tong

Keyword(s):

Randomized Controlled Trial ◽

Neck Pain ◽

Controlled Trial ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Randomized Controlled ◽

Auricular Point ◽

Axial Neck Pain

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How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion?

The Spine Journal ◽

10.1016/j.spinee.2020.10.033 ◽

2020 ◽

Author(s):

Srikanth N. Divi ◽

Wesley H. Bronson ◽

Jose A. Canseco ◽

Michael Chang ◽

Dhruv K.C. Goyal ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Patient Reported

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Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Journal of Neurosurgery Spine ◽

10.3171/2017.6.spine17288 ◽

2018 ◽

Vol 28 (2) ◽

pp. 160-166 ◽

Cited By ~ 11

Author(s):

Ankur S. Narain ◽

Fady Y. Hijji ◽

Brittany E. Haws ◽

Krishna T. Kudaravalli ◽

Kelly H. Yom ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Surgical Outcomes ◽

Hospital Costs ◽

Normal Weight ◽

Anterior Cervical Discectomy ◽

Postoperative Outcomes ◽

Cervical Discectomy ◽

Chi Square Analysis ◽

Reoperation Rates

OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Journal of Speech Language and Hearing Research ◽

10.1044/2016_jslhr-s-16-0091 ◽

2017 ◽

Vol 60 (4) ◽

pp. 785-793 ◽

Cited By ~ 6

Author(s):

Lydia Muss ◽

Janina Wilmskoetter ◽

Kerstin Richter ◽

Constanze Fix ◽

Soenke Stanschus ◽

...

Keyword(s):

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Anterior Cervical Discectomy ◽

Future Research ◽

Swallowing Function ◽

Pharyngeal Wall ◽

Cervical Discectomy ◽

Functional Measures ◽

Posterior Pharyngeal Wall Thickness ◽

The Impact

Purpose The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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