Intravenous and Local Steroid Use in the Management of Dysphagia After Anterior Cervical Spine Surgery: a Systematic Review of Prospective Randomized Controlled Trails (RCTs)

Purpose: To conduct a high-level systematic review of the literature to evaluate intravenous and local steroid use in the management of dysphagia after anterior cervical spine surgery.

Methods: We searched the database PubMed, EMBASE, Clinical key, the Cochrane library and Wiley Online Library without time restriction using the terms 'dysphagia' or 'odynophagia' or 'swallowing disorder,' 'steroid,' 'anterior cervical spine surgery.' Randomized controlled trails (RCTs) were selected, and effects of intravenous and local steroids were investigated from these studies.

Results: The initial search yielded 67 citations. Six of these studies met the inclusion and exclusion criteria. All of them were prospective RCTs which were evaluated as level 1 evidence. One study found that perioperative intravenous steroid use is not effective in reducing severity of early postoperative dysphagia after one-level ACDF, while five studies suggested that perioperative intravenous and local steroid use seemed to be more effective on reducing incidence and severity of early dysphagia after multilevel ACSS. One double-blinded study still found that locally administered depomedrol on a collagen sponge significantly decreases early dysphagia incidence and severity after ACSS using low-dose BMP.

Conclusions: Perioperative intravenous and local steroid use could reduce incidence and severity of early dysphagia after ACSS postoperatively, especially for multilevel surgeries. For the patients underwent revision surgery or at high risk for pseudarthrosis having to use BMP during surgery, locally administered depomedrol on a collagen sponge was suggested to decrease early dysphagia incidence and severity after ACSS. These slides can be retrieved under Electronic Supplementary Material.