Effect of Local Steroid Injection on Prevertebral Soft Tissue Swelling Following Anterior Cervical Discectomy and Fusion

Afsoun Seddighi--- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Amir Nikouei--- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Amir Saied Seddighi--- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Yasaman Arjmand--- Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract


8

Background: Prevertebral soft tissue swelling (PSTS) following anterior cervical surgery, may proceed to airway compromise which is potentially lethal. We plan to evaluate the effect of local steroid injection to reduce PSTS after anterior cervical discectomy and fusion (ACDF).

Methods: In a randomized clinical trial 66 patients who underwent ACDF involving one to three segments due to radiculopathy or myelopathy were enrolled and randomly divided to two groups of 38 with local injection of 80 mg methylprednisolone in operation site, and control. Prevertebral soft tissue thickness to mid anteroposterior vertebral body diameter (S/V) ratio was defined to assess PSTS. In addition, dysphagia and pain at surgery site was evaluated using Bazaz dysphagia scale and Visual Analogue Scale (VAS) respectively, at 1st, 5th and 10th post-operative days.

Results: We have observed significantly lower S/V ratio in all studied vertebrae, except C6 on second postoperative day in case group. At the end of the 6th month, there was no significant difference for S/V ratio in any level in two groups. Severity of dysphagia was significantly lower in 1st, 5th and 10th post-operative day in patients in case group. (P value<0.05) Also, patients in case group experienced significantly less severe odynophagia at 1st, 5th and 10th post-operative day, which was assessed by VAS. (P value<0.05)

Conclusions: The use of local methyl prednisolone in prevertebral space is a simple and effective method to reduce PSTS and severity of dysphagia and odynophagia. Furthermore, this method was not associated with any adverse effects. 


Keywords


Prevertebral soft tissue swelling; Anterior discectomy and fusion; Steroid; Visual Analogue Scale; dysphagia

Full Text:

PDF

6

References


Kim YJ, Oh SH, Yi HJ, Kim YS, Ko Y, Oh SJ. Myelopathy caused by soft cervical disc herniation: surgical results and prognostic factors. J Korean Neurosurg Soc. 2007;42(6):441-5.

Storm PB, Chou D, Tamargo RJ. Surgical management of cervical and lumbosacral radiculopathies: Indications and outcomes. Phys Med Rehabil Clin N Am. 2002;13(3):735–759.

Foster NE, Thompson KA, Baxter GD, Allen JM. Management of nonspecific low back pain by physiotherapists in Britain and Ireland: A descriptive questionnaire of current clinical practice. Spine. 1999;24(13):1332–1342.

Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168-174.

Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007;32(21):2310-7.

Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976). 2002;27(9):949-53.

Ban D, Liu Y, Cao T, Feng S. Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur J Med Res. 2016;21(1):34.

Riley III LH, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study (presented at the 2004 CSRS Meeting). Spine. 2005;30(22):2564-9.

Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011; 335(1): 2–13.

Pedram M, Castagnera L, Carat X, Vital JM. Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone. Eur Spine J. 2003;12(1):84–90.

Jeyamohan SB, Kenning TJ, Petronis KA, Feustel PJ, Drazin D, DiRisio DJ. Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial. J Neurosurg Spine. 2015;23(2):137-43.

Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999. Spine (Phila Pa 1976). 2003;28(9):931–939.

Albers HW, Hresko MT, Carlson J, Hall JE. Comparison of single-and dual-rod techniques for posterior spinal instrumentation in the treatment of adolescent idiopathic scoliosis. Spine. 2000;25(15):1944-9.

Davis WL, Harnsberger HR. CT and MRI of the normal and diseased perivertebral space. Neuroradiology. 1995;37(5):388-94.

Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year follow-up study. Eur Spine J. 2005;14(7):677-82.

Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J. Airway compromise due to wound hematoma following anterior cervical spine surgery. Open Orthop J. 2012;6:108.

Seddighi A, Nikouei A, Seddighi AS, Zali A, Tabatabaei SM, Yourdkhani F, et al. The role of tranexamic acid in prevention of hemorrhage in major spinal surgeries. Asian J Neurosurg. 2017;12(3):501.

Marotta N, Landi A, Tarantino R, Mancarella C, Ruggeri A, Delfini R. Five-year outcome of stand-alone fusion using carbon cages in cervical disc arthrosis. Eur Spine J. 2011;20(1):8-12.

Inokuchi G, Kurita N, Baba M, Hata Y, Okuno T. Retropharyngeal hematoma from parathyroid hemorrhage in a hemodialysis patient. Auris Nasus Larynx. 2012;39(5):527-30.

Arjmand Y, Torkian P, Keipourfard A. Radiologic Evaluation of Patients with Glioblastoma Multiforme who Initially Presented with Ischemic Stroke: A Case Series. American Journal of Medical Case Reports. 2017;5(1):8-11.

Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2-13.

Nam TW, Lee DH, ShiN JK, Goh TS, Lee JS. Effect of intravenous dexamethasone on prevertebral soft tissue swelling after anterior cervical discectomy and fusion. Acta Orthop Belg. 2013;79(2):211-5.

Lee SH, Kim KT, Suk KS, Park KJ, Oh KI. Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study. Spine. 2011;36(26):2286-92.

Sanfilippo Jr JA, Lim MR, Jacoby SM, Laterra R, Harrop JS, Vaccaro AR, et al. “Normal” prevertebral soft tissue swelling following elective anterior cervical decompression and fusion. J Spinal Disord Tech. 2006;19(6):399-401.

Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech. 2002;15(5):362–8.

Daniels AH, Riew DK, Yoo JU, Ching A, Birchard KR, Kranenburg AJ, et al. Adverse events associated with anterior cervical spine surgery. J Am Acad Orthop Surg. 2008;16(12):729–38.

Song KJ, Choi BW, Kim HY, Jeon TS, Chang H. Efficacy of postoperative radiograph for evaluating the prevertebral soft tissue swelling after anterior cervical discectomy and fusion. Clin Orthop Surg. 2012;4(1):77–82.

Stachniak JB, Diebner JD, Brunk ES, Speed SM. Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein-2 in patients at risk for pseudarthrosis. J Neurosurg Spine 2011;14(2):244–9.

Khaki F, Zusman NL, Nemecek AN, Ching AC, Hart RA, Yoo JU. Postoperative prevertebral soft tissue swelling does not affect the development of chronic dysphagia following anterior cervical spine surgery. Spine. 2013;38(9):E528–32.

Seddighi A, Nikouei A, Seddighi AS, Zali AR, Tabatabaei SM, Sheykhi AR, et al. Peripheral nerve injury: a review article. International Clinical Neuroscience Journal. 2016;3(1):1-6.

Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002;27(22):2453–8.




DOI: http://dx.doi.org/10.22037/icnj.v4i3.18461

Refbacks

  • There are currently no refbacks.