Zadegan Shayan Abdollah, Jazayeri Seyed Behnam, Abedi Aidin, Bonaki Hirbod Nasiri, Vaccaro Alexander R, Rahimi-Movaghar Vafa
Tehran University of Medical Sciences, Tehran, Iran.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Global Spine J. 2018 May;8(3):286-302. doi: 10.1177/2192568217708776. Epub 2017 Jun 23.
Systematic review.
Anterior cervical approach is associated with complications such as dysphagia and airway compromise. In this study, we aimed to systematically review the literature on the efficacy and safety of corticosteroid administration as a preventive measure of such complications in anterior cervical spine surgery with fusion.
Following a systematic literature search of MEDLINE, Embase, and Cochrane databases in July 2016, all comparative human studies that evaluated the effect of steroids for prevention of complications in anterior cervical spine surgery with fusion were included, irrespective of number of levels and language. Risk of bias was assessed using MINORS (Methodological Index for Non-Randomized Studies) checklist and Cochrane Back and Neck group recommendations, for nonrandomized and randomized studies, respectively.
Our search yielded 556 articles, of which 9 studies (7 randomized controlled trials and 2 non-randomized controlled trials) were included in the final review. Dysphagia was the most commonly evaluated complication, and in most studies, its severity or incidence was significantly lower in the steroid group. Although prevertebral soft tissue swelling was less commonly assessed, the results were generally in favor of steroid use. The evidence for airway compromise and length of hospitalization was inconclusive. Steroid-related complications were rare, and in both studies that evaluated the fusion rate, it was comparable between steroid and control groups in long-term follow-up.
Current literature supports the use of steroids for prevention of complications in anterior cervical spine surgery with fusion. However, evidence is limited by substantial risk of bias and small number of studies reporting key outcomes.
系统评价。
颈椎前路手术会引发吞咽困难和气道受压等并发症。在本研究中，我们旨在系统回顾有关皮质类固醇给药作为颈椎前路融合手术中此类并发症预防措施的有效性和安全性的文献。
2016年7月对MEDLINE、Embase和Cochrane数据库进行系统文献检索后，纳入所有评估类固醇对颈椎前路融合手术并发症预防效果的比较性人体研究，不考虑手术节段数量和语言。分别使用MINORS（非随机研究方法学指数）清单和Cochrane背部与颈部小组建议对非随机研究和随机研究进行偏倚风险评估。
我们的检索共得到556篇文章，其中9项研究（7项随机对照试验和2项非随机对照试验）纳入最终评价。吞咽困难是最常评估的并发症，在大多数研究中，类固醇组其严重程度或发生率显著更低。虽然椎体前软组织肿胀较少被评估，但结果总体上支持使用类固醇。关于气道受压和住院时间的证据尚无定论。类固醇相关并发症罕见，在两项评估融合率的研究中，长期随访类固醇组和对照组的融合率相当。
当前文献支持在颈椎前路融合手术中使用类固醇预防并发症。然而，证据受到偏倚风险大以及报告关键结局的研究数量少的限制。
