Topical steroids reduce swallowing difficulties following ACDF surgery

Todd Albert

A study presented as part of the AAOS 2020 Virtual Education Experience has found that topical steroids administered during anterior cervical discectomy and fusion (ACDF) surgery help reduce swallowing difficulties following the procedure. The findings were presented by lead investigator Todd Albert, surgeon-in-chief emeritus at the Hospital for Special Surgery, New York, USA.

“Although ACDF is a popular approach with a high success rate, one of the more common complications is the development of post-operative dysphagia, which is trouble swallowing,” said Albert. He explained that the severity of dysphagia experienced by patients following ACDFs can range from a mild and subjective discomfort such as fullness of the throat and soreness to a serious medical issue such as malnutrition, social isolation, 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,” he added.

Albert and colleagues launched the study to determine if administering topical steroids behind the oesophagus during surgery could reduce the swallowing problems some patients experience after the procedure. Patients scheduled for multilevel ACDF surgery were enrolled and randomised into two groups in a double-blind fashion. The steroid group received 40 mg of methylprednisolone delivered in an absorbable gel matrix prior to the completion of surgery. The control group received the absorbable gel without the steroid.

“To reduce any possible bias associated with the study, our hypothesis was that there would be no difference in swallowing difficulty between the patients who receive intraoperative topical steroids and those who do not receive the steroids,” Albert noted.

Ninety-five patients were included in the final analysis; 48 received the steroid and 47 were in the control group. The mean age was 57 years old, and 52% of patients were male. Comparison of the two groups revealed no significant differences in demographics, diagnosis, number of levels fused in the cervical spine or time necessary to perform the surgery.

After the procedure, patients in both groups completed validated questionnaires to evaluate their ability to eat and swallow. The analysis revealed that the group receiving the steroids had significantly better dysphagia scores than the control group.

“Our study demonstrated the benefit of intraoperative steroids with this delivery method to prophylactically reduce swallowing difficulty following ACDF surgery,” the researchers noted. “The early post-operative results were superior for the group who received the topical steroids, especially at two days following surgery, and maintained at one month.” Investigators are planning a future study to evaluate long-term outcomes when steroids are used in ACDF surgery.


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