Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study.
METHODS
A prospective, randomized study.


OBJECTIVE
To analyze the effect of local retropharyngeal steroid to reduce prevertebral soft tissue swelling (PSTS) after anterior cervical discectomy and fusion (ACDF).


BACKGROUND
There have been several reports on intravenous corticosteroid to prevent airway complication without a consensus; however, there have been no reports to date that have discussed the use of local steroids to reduce PSTS.


METHODS
Fifty cases that underwent ACDF involving 1 or 2 segments were enrolled. The mean follow-up period was 22 months. Of the 25 cases randomly selected as the steroid group, a mixture of triamcinolone and morcellized collagen sponge was applied to the retropharyngeal space before wound closure. For the control group, the other 25 cases received the operation without steroid. We measured the PSTS ratio to vertebral body from C3 to 7 and PSTS index (PSTSI; mean of PSTS ratio at C3, 4, and 5) on cervical spine. Simple lateral radiographs were taken preoperatively, immediately after operation, and at postoperative 2 days, 4 days, 2 weeks, and the last follow-up. The changes in odynophagia, radiological union, Neck Disability Index were analyzed.


RESULTS
The PSTS ratio of the steroid group was significantly lower on C3 and C4 immediately after operation, on C3, 4, 5 and C6 at postoperative 2 days, on C3, 4, and 5 at 4 days. The differences of PSTSI (the steroid: control group) maintained at 58.2: 74.3% (P = 0.004) immediately after operation, 57.9: 84.1% (P = 0.000) at 2 days, 56.3: 82.9% (P = 0.000) at 4 days, and 44.9: 51.4% (P = 0.037) at 2 weeks. The mean Visual Analogue Scale for odynophagia was significantly lower in the steroid group until postoperative 2 weeks. The last follow-up showed no significant difference in the radiological and clinical outcome.


CONCLUSIONS
Using the retropharyngeal local steroid, we significantly reduced PSTS and odynophagia following ACDF without additional complication. This method may be considered a simple and effective method to decrease PSTS following anterior cervical spine surgery.
Department of Orthopedic Surgery, Spine Center, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.
Sang-Hun
SH
Lee
Ki-Tack
KT
Kim
Kyung-Soo
KS
Suk
Kyoung-Jun
KJ
Park
Kyung-Il
KI
Oh
D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D017586:Diskectomy / Q000009:adverse effects*; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010614:Pharynx; D011446:Prospective Studies; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*
D005938:Glucocorticoids; D014221:Triamcinolone