A study conducted at the Hospital for Special Surgery (HSS) in New York City, sought to find an easy way to reduce dysphagia, or difficulties swallowing, after anterior cervical discectomy and fusion (ACDF) surgery.
Topical Steroids Help Reduce Dysphagia After ACDF
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Dysphagia is a common complaint after ACDF surgery due to inflammation and physical irritation due to hardware and has led to the reduction in plate profile height, and zero-profile standalone cages for ACDF surgery. It is also one reason why rhBMP-2 is not indicated for use in the cervical spine. The study was originally published in The Spine Journal in September 2019, but has recently been included in the American Academy of Orthopaedic Surgeons (AAOS) 2020 Virtual Education Experience and presented in March 2020.
Surgeon-in-Chief Emeritus at HSS, Todd Albert, M.D., was lead investigator on the study. He explained that the severity and duration of dysphagia can vary among patients and range from mild and subjective discomfort or lead to malnutrition, aspiration pneumonia, or airway obstruction. “Many studies show that most dysphagia-related symptoms occur in the early phase of the recovery period and gradually dissipate over time.”
The double-blind, randomized study consisted of 95 patients randomized to either 40mg of methylprednisolone in an absorbable gel, or the absorbable gel without steroid. The gel was applied in the surgical site after multi-level ACDF surgery prior to closure. Both groups of patients were similar in terms of demographics, diagnosis and surgery performed. Validated questionnaires (EAT-10 and SWAL-QOL) were used to evaluate patients’ ability to swallow and eat.
By postoperative day 2, the steroid-treated patients scored significantly better in many metrics compared with the control group. At one month after surgery significant benefits were still observed in eating desire, eating duration, fear swallowing, and fatigue.
The study shows that a simple and inexpensive topical steroid applied perioperatively can significantly reduce dysphagia in patients undergoing ACDF. The researchers noted, “Our study demonstrated the benefit of intraoperative steroids with this delivery method to prophylactically reduce swallowing difficulty following ACDF surgery.” The group plans to investigate the long-term effects of steroids for ACDF in a future study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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