HSS Study: Swallowing Problems Don’t Have to Accompany Anterior Cervical Discectomy and Fusion

by Elizabeth Hofheinz, M.P.H., M.Ed.

When conservative treatment methods fail for those enduring cervical spine/neck pain, surgeons and patients may opt for anterior cervical discectomy and fusion (ACDF). The postop period, however, is often aggravated by, well, the aggravation of swallowing problems.

But after studying 106 patients who underwent SCDF, researchers from Hospital for Special Surgery (HSS) have determined that topical steroids administered during the procedure can help reduce postoperative swallowing difficulties. This study is available online as part of the AAOS 2020 Virtual Education Experience; it was published in The Spine Journal in September 2019.

“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 Todd Albert, M.D., lead investigator and surgeon-in-chief emeritus at HSS. “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.”

Patients scheduled for 2-4 ACDF surgery were enrolled and randomized into two groups (double-blinded). The steroid group received 40 mg of methylprednisolone delivered in an absorbable gel matrix. 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,” Dr. Albert noted.

A total of 95 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.

Postoperatively, all patients completed validated questionnaires to evaluate their ability to eat and swallow. The group that received the steroid treatment 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.

Asked what gave him the idea to use steroids, Dr. Albert told OSN, “Lots of prior authors had used steroids delivering them in various ways, but there had never been a well-done scientific study testing the hypothesis that they were useful in improving swallowing after ACDF.”

And what about the patients who should not receive these, Dr. Albert noted, “Certainly, if there is any sign of infection or injury to the esophagus or local structures, patients should not receive steroids. Some might argue they should be used with caution (or at least with increased awareness) in diabetic patients as they can cause an increase in the blood glucose.”

Going forward, Dr. Albert and his colleagues will pursue further research in this arena. “We are interested to look back on these patients and see if there is an impact on the fusion,” Dr. Albert told OSN. “Therefore, after a period of time, we will review the study patients and determine fusion rates for those who received steroids vs not with respect to their fusion status.”