Commentary on the effect of steroid use in anterior cervical discectomy and fusion surgery; a randomized controlled trial by Shiveindra B. et al. Journal of Neurosurgery Spine 2015;23:137-43.

Abstract

Background:Steroids are often used in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery to limit postoperative dysphagia. However, a major concern remains steroids’ impact is on fusion.Methods:In this prospective, randomized, double-blinded controlled study, the authors assessed the impact of steroids on swallowing/airway and fusion rates in 112 patients undergoing multilevel ACDF. The patients were randomly assigned to saline or dexamethasone groups prior to surgery; multiple other variables including different outcome analyses were also utilized over a 2-year postoperative period. The patients were followed for 1, 3, 6, 12, and 24 months postoperatively, and computed tomography (CT) studies were performed at 6, 12, and 24 postoperative months to establish fusion.Results:The authors found no significant 2-year differences in the clinical parameters or surgical outcomes for patients undergoing ACDF with or without steroids. Steroids reduced dysphagia in the 1st postoperative month, produced a “trend” for reducing postoperative airway complications (e.g., intubation), and length of stay. Notably, CT-fusion rates with steroids were reduced at the 6th postoperative month but equalized by the 1st postoperative year.Conclusions:The authors concluded that dexamethasone administered at the time of ACDF surgery improved swallowing within the 1st postoperative month, reduced perioperative airway complications, reduced the length of stay, and reduced 6 month but not 12 month fusion rates. Although the findings regarding postoperative dysphagia are helpful, the performance of multiple 3D-CT scans postoperatively to document fusion would appear to subject these patients to excessive radiation exposure without sufficient clinical indications.