Abstract

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). Methods: We conducted a Prospective randomized study involving 50 patients (25 cases/25 controls) undergoing Single level surgery with identical plate (thickness) and cage inserted (ACDF). Study was conducted at Artemis Hospital, Delhi NCR, India from July 2019 to March 2021. All the patients were operated using standard Smith Robinson approach (left sided approach) by single surgical team. All the patients were between the age group of 18-60 years with symptoms of neck pain and radicular pain. Standard ACDF procedure was carried out using cage and plate. In 25 patients, a Gelfoam with methylprednisolone 80 mg was placed in the retropharyngeal space over the plate 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 5 on cervical spine. Simple lateral radiographs were taken preoperatively, at postoperative 2 days, 7 days, 2 weeks. To compare the groups, the average value of PSTS at C3, C4, and C5 is observed and measured in millimeters (mm). Dysphagia was evaluated in the same way using Bazaz Dysphagia Score. Result: The mean age in case group was 49.40 years whereas in control group was 50.20 years. In case group, there were 11 male and 14 females, while in control group 10 patients were male and 15 patients were female. Preoperatively there was no statistical difference between the prevertebral soft tissue swelling (in mm) in both the groups at C3, C4, C5. However, In the post-operative period (2nd and 7th day), there was significant difference (p-values of less than 0.05) between the prevertebral soft tissue swelling at C3,C4 and C5. On 14th post-operative day the prevertebral soft tissue swelling at C3, C4 and C5 was not significant with the p-values of more than 0.05. We used Dysphagia-BAZAZ SCORE: On the post-operative day 2, there was a statistically significant difference between the two groups based on ‘BAZAZ score’ for both liquids and solids (p value 0.016 for liquids and 0.045 for solids). On the 7th day also, there was a statistically significant difference between the two groups based on ‘BAZAZ score’ for both liquids and solids (p-value 0.045 for liquids and 0.035 for solids). The last follow-up showed no significant difference in the radiological and clinical outcome. Conclusion: There is significant decrease in the prevertebral soft tissue swelling and post-operative dysphagia by administrating local steroid before closure of surgical incision. This method may be considered a simple and effective method to decrease PSTS following anterior cervical spine surgery.

Description

.