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- Fig. 1
PRISMA flow diagram for systematic reviews.
Tables
- Table 1
Summary of assessments used to measure dysphagia and highlights of individual study outcomes.
Study, year Dysphagia Severity Assessment Assessment Description Results Conclusion SYSTEMIC STEROIDS Pedram, 2003 N/a Patient subjectively described swallowing difficulty without standardized scale Dysphagia or odynophagia reported 24-36h post-operatively in 56 (71.79%) steroid-treated patients compared to 130 (82.28%) control patients. Perioperative systemic steroids reduce incidence of post-operative swallowing impairment in the early post-operative period. Nam, 2013 Visual analogue scale (VAS) for dysphagia 10-point scale based on patient self-report of swallowing difficulty (0 = no difficulty swallowing, 10 = worst difficulty swallowing). No statistically significant differences in mean VAS scores between high dose steroids, low dose steroids, and control groups noted during the first 5 post-op days. Perioperative systemic steroids do not affect severity of post-operative swallowing impairment in the early post-operative period. Song, 2014 Bazaz Dysphagia Score Dysphagia described as absent, mild, moderate, severe based on patient report. Steroid group had lower Bazaz ratings compared to control group during POD 2-5 (p<0.05 each day). . Perioperative systemic steroids improve post-operative severity in the early post-operative period. Jeyamohan, 2015 Functional Outcome Swallowing Scale (FOSS) Score 0-5 based on patient report of swallowing function, frequency of associated symptoms, and need for non-oral feeding Steroid group lower mean FOSS score at 1-month follow-up compared to control group (0.064 vs. 0.66, p=0.027); this difference disappeared after 1 month. Perioperative systemic steroids improve post-operative dysphagia severity in the early post-operative period, which subsides in the long-term. LOCAL STEROIDS Lee, 2011 Visual analogue scale (VAS) for odynophagia 10-point scale based on patient self-report of pain with swallowing (0 = no pain; 10 = worst pain). Steroid group exhibited statistically significant lower mean VAS odynophagia scores immediately and at 2-weeks post-operation. Perioperative local steroids reduce post-operative dysphagia in the early post-operative period. Cancienne, 2015 N/a Patient subjectively described swallowing difficulty without normalized scale 9% of steroid group vs. 14.6% of control group experienced dysphagia within 90 days of fusions with 3 or more levels (p=0.005). Perioperative local steroids reduce incidence of post-operative dysphagia in patients undergoing anterior cervical spinal fusion of 3 or more levels. Koreckij, 2016 Bazaz Dysphagia Scale Dysphagia described as absent, mild, moderate, severe based on patient report. Steroid group had fewer patients with severe dysphagia at 6 weeks post-op (14.3% vs.40.9%, p=0.008.) and 3 month (0% vs. 23.9%, p=0.022) compared to controls. Perioperative local steroids improve post-operative dysphagia severity beyond the early post-operative period. EAT-10: A swallowing screening tool 10 item questionnaire evaluating swallowing and associated psychosocial issues. Each item scored 0-4 (0=no problem, 4=severe problem). Total score ranges from 0-40. Total score of 3 or higher is abnormal (indicative of dysphagia). Steroid group had fewer patients with abnormal EAT-10 scores at 3 months post-op in comparison to control group (18.2% vs. 57.1%; p=0.012). Perioperative local steroids reduce incidence of dysphagia in the late post-operative period. POD: post-operative day.
- Table 2
Summary of patient and study demographics of patients receiving steroids after anterior cervical spine surgery.
Author, Year Design Total number of patients included Number of operative levels Number of multilevel surgeries included, n (%) Major indications for initial anterior cervical spinal surgery Follow-up intervals Demographics of Com rol Patient! Demograiphics of Intervention Patients Total Patients Mean Age (in years) +/- SD % Male Control administered Total patients Mean Age +/- SD % Male Intervention administered Steroid Dose Frequency Steroid Dose Equivalent* SYSTEMIC STEROIDS Pedram, 2003 RCT 236 1-5 66 (28) Cervical canal stenosis, herniated disc, trauma 24-36h PO 158 47+/-15.3 (range: 15-88) n/a N/A 78 47+/-12.3 (range: 17-83) n/a IV Methylprednisolone 0h, 12h, 24h 0.19 mg/kg Nam, 2013 RCT 62 1 0 (0) Cervical radiculopathy Daily POD 0-5 22 48.8 80 NS High dose: 20
Low dose: 20High dose: 46.9 +/- 8.6
Low dose:45.6+/-7.3High dose: 55
Low dose: 70IV Dexamethasone 0h, 24h, 48h High dose: 20/10/10mg
Low dose: 10/5/5mgSong, 2014 RCT 40 >3 40 (100) Cervical radiculopathy, myelopathy Daily POD 1-discharge 20 57.3+/-11 (range:
29-77)80 N/A 20 59.9+/-10.3
(range: 42-47)70 IV Methylprednisolone 0h, 6h, 12h, 18h, 24h 46.88mg Jeyamohan, 2015 RCT 112 ≥2 112 (100) Cervical spondylosis 1mo, 3mo,
6mo, 12mo,
24mo56 55 48.22 NS 56 54 58.93 IV dexamethasone IO, 6h, 12h, 18h, 24h 0.20mg/kg IO, 0.06mg/ kg PO LOCAL STEROIDS Lee, 2011 RCT 50 1-2 21 (42) Cervical radiculopathy, myelopathy POD 0, 2, 4, 2wk 25 50.9 56 N/A 25 54.3 72 RP triamcinolone IO 7.50mg Cancienne, 2015 Retrospective case control 245754 Short surgery:1-2
Long surgery: >3n/a n/a Within POD 0-90 243,662 n/a Short surgery: 47
Long surgery: 47.5N/A 2092 n/a Short surgery: 40.3
Longsurgery: 42.1RP
Triamcinolone or methylprednisoloneIO 0.19mg, 1.88mg,
3.75mg,
7.5mg, 15mgKoreckij, 2016 Retrospective case control 44 2-4 44 (100) Cervical radiculopathy, myelopathy POD 1,
6wk, 3mo22 57.6+/-9.9 50 IV dexamethasone 10mg 22 55.1 +/-7.9 54.5 IV dexamethasone
10mg + RP
methylprednisoloneIO 15mg 0h: immediately post-operatively; NS: Normal saline; IO: intraoperative; IV: intravenous; Long surgery: operated on 3 or more spinal levels; Mo: month; PO: post-operative; POD: post-operative day ; RP: retropharyngeal; Short surgery: operated on <3 spinal levels ; Wk: week.
↵* Dose equivalents relative to dexamethasone.
Severity Problems swallowing liquids Problems swallowing solids None None None Mild None Rare Moderate None/rare Occasionally (only with specific foods) Severe None/rare Frequent (majority of food) Score Symptoms 0 Normal function; asymptomatic 1 Normal function; episodic or daily symptoms of dysphagia 2 Compensated abnormal function manifested by significant dietary modifications or prolonged mealtimes w/o weight loss or aspiration 3 Decompensated abnormal function; daily coughing, gagging, aspiration during meals 4 Severely decompensated abnormal function; severe aspiration & bronchopulmonary complications; non-oral feeding for most nutrition 5 Non-oral feeding for all nutrition
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