Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
Neurosurg Rev. 2022 Feb;45(1):63-70. doi: 10.1007/s10143-019-01207-z. Epub 2021 May 12.
Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local corticosteroid application on dysphagia, its safety and efficacy are still unclear. A systematic review was performed aiming to evaluate the evidence of local corticosteroid application in prevention or treatment of postoperative dysphagia following ACSS. A systematic search was performed in September 2018 in PubMed and Embase database. The following information was extracted: study investigator, year of publication, number of patients, study design, inclusion/exclusion criteria, administration protocol of steroid, type of surgical procedure, number of levels performed, assessment methodology of dysphagia, radiologic assessment of prevertebral soft tissue swelling (PSTS), follow-up time points, outcome of dysphagia, and corticosteroid-related complications. Qualitative synthesis was performed. Finally, 5 studies met the inclusion/exclusion criteria. Four studies found that local corticosteroid application could decrease the incidence and magnitude of postoperative dysphagia while 1 study showed no effect on dysphagia significantly at 6 weeks and 3 months follow-up time. A total of 2325 patients received local corticosteroid intraoperatively; no early corticosteroid-related complication was reported. Totally, 4 adverse events occurred in long-term follow-up time, including 2 bone nonunion at 1.5 and 2.5 years postoperatively, 2 esophageal perforation at 2 months and 11 months of follow-up, respectively. Local corticosteroid application can reduce the incidence and severity of dysphagia following ACSS without increasing early corticosteroid-related complications. But further high-quality study is necessary to analyze potential delayed complications.
吞咽困难是颈椎前路手术后的常见并发症。尽管有几项文献报道了局部应用皮质类固醇对吞咽困难的潜在益处，但它的安全性和疗效仍不清楚。本系统评价旨在评估局部应用皮质类固醇预防或治疗颈椎前路手术后吞咽困难的证据。2018 年 9 月，我们在 PubMed 和 Embase 数据库中进行了系统检索。提取的信息包括：研究人员、发表年份、患者数量、研究设计、纳入/排除标准、类固醇给药方案、手术类型、手术节段数、吞咽困难评估方法、颈椎前路手术前后软组织肿胀（PSTS）的影像学评估、随访时间点、吞咽困难的结果以及皮质类固醇相关并发症。进行定性综合。最终，符合纳入/排除标准的研究有 5 项。其中 4 项研究发现局部皮质类固醇应用可降低术后吞咽困难的发生率和严重程度，而 1 项研究在 6 周和 3 个月的随访时间点时发现对吞咽困难无明显影响。共有 2325 例患者在术中接受了局部皮质类固醇治疗；没有早期皮质类固醇相关并发症的报道。在长期随访中，共发生 4 例不良事件，包括术后 1.5 年和 2.5 年发生 2 例骨不愈合，2 例食管穿孔分别发生在术后 2 个月和 11 个月。局部皮质类固醇应用可降低颈椎前路手术后吞咽困难的发生率和严重程度，而不会增加早期皮质类固醇相关并发症。但需要进一步的高质量研究来分析潜在的迟发性并发症。
