Department of Orthopedic Surgery, Spine Center, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.
Spine (Phila Pa 1976). 2011 Dec 15;36(26):2286-92. doi: 10.1097/BRS.0b013e318237e5d0.
A prospective, randomized study.
To analyze the effect of local retropharyngeal steroid to reduce prevertebral soft tissue swelling (PSTS) after anterior cervical discectomy and fusion (ACDF).
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.
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.
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.
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.
前瞻性、随机研究。
分析颈椎前路椎间盘切除融合术（ACDF）后局部咽后类固醇对减少椎体前软组织肿胀（PSTS）的效果。
已有几篇关于静脉内皮质类固醇预防气道并发症的报道，但尚未达成共识；然而，目前尚无关于使用局部类固醇来减少 PSTS 的报道。
纳入了 50 例接受 ACDF 手术的患者，涉及 1 或 2 个节段。平均随访时间为 22 个月。随机选择的 25 例类固醇组患者在伤口关闭前将曲安奈德和切碎的胶原蛋白海绵混合物应用于咽后间隙。对照组的另外 25 例患者未接受类固醇治疗。我们测量了 C3 至 7 椎体的 PSTS 比值和 PSTS 指数（C3、4 和 5 的 PSTS 比值平均值）。颈椎术前、术后即刻、术后 2 天、4 天、2 周和末次随访时拍摄简单的侧位片。分析吞咽困难、影像学融合、颈部残疾指数的变化。
类固醇组患者术后即刻 C3 和 C4 的 PSTS 比值明显降低，术后 2 天 C3、4、5 和 C6，术后 4 天 C3、4 和 5 的 PSTS 比值降低。PSTS 指数（类固醇组：对照组）的差异在术后即刻仍维持在 58.2:74.3%（P=0.004），术后 2 天为 57.9:84.1%（P=0.000），术后 4 天为 56.3:82.9%（P=0.000），术后 2 周为 44.9:51.4%（P=0.037）。类固醇组患者的吞咽困难视觉模拟评分在术后 2 周内明显较低。末次随访时，影像学和临床结果无显著差异。
使用咽后局部类固醇可显著减少 ACDF 后 PSTS 和吞咽困难，且无额外并发症。这种方法可能被认为是减少颈椎前路手术后 PSTS 的一种简单有效的方法。
