Veliky Cole, Shahzad Hania, Ibrahim Muhammad Talal, Alvarez Paul Michael, Epitropoulos Frank, Singh Varun
The Ohio State University College of Medicine, United States.
The Ohio State University Wexner Medical Center, Department of Orthopedics, United States.
J Orthop. 2024 Sep 19;61:54-60. doi: 10.1016/j.jor.2024.09.014. eCollection 2025 Mar.
The study aims to analyze the utility of peri-operative systemic intravenous (IV) steroids in mitigating postoperative complications and improving clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery.
A systematic review was conducted by searching PubMed, Scopus, Cochrane, Web of Science, and Embase databases for studies assessing the role of IV or systemic steroids in ACDF surgery. Data extraction and risk of bias assessment were conducted independently by two reviewers using Covidence, with a third reviewer finalizing the data and settling any conflicts. The systematic review was conducted per PRISMA guidelines and registered on Prospero under the title, Investigating the Effectiveness of Early "SYSTEMIC" (oral or IV) Steroid Administration, within a 24-hour to one-week timeframe post-operatively, in Anterior Cervical Discectomy and Fusion (ACDF): A Systematic Review. The Risk of Bias 2.0 (RoB 2.0) tool was used for clinical trials, and the Newcastle-Ottawa Scale (NOS) was used for retrospective studies.
Six studies were included and showed that IV steroids effectively mitigated dysphagia for up to a month, with higher efficacy compared to topical steroids used intraoperatively. However, IV steroids did not significantly impact the incidence of paravertebral swelling. Reductions in dysphonia, pain scores, and airway compromise were observed, but their long-term effects were insignificant. Systemic steroids were also found to delay fusion in some cases for up to six months, but long-term healing and fusion were not significantly impacted.
The use of IV steroids in the perioperative period after ACDF surgery is beneficial in mitigating dysphagia, with multiple doses showing long-term effectiveness compared to the transient effects of local steroids used intraoperatively. Patients may experience perceived benefits in terms of airway compromise, pain, and dysphonia without significant systemic complications or fusion failure. However, there is limited evidence regarding the optimal steroid dosing, frequency, and formulation and thus strong recommendations cannot be made.
本研究旨在分析围手术期全身静脉注射类固醇在减轻术后并发症及改善颈椎前路椎间盘切除融合术（ACDF）后的临床结局方面的效用。
通过检索PubMed、Scopus、Cochrane、科学网和Embase数据库进行系统评价，以查找评估静脉注射或全身类固醇在ACDF手术中作用的研究。两名评价者使用Covidence独立进行数据提取和偏倚风险评估，第三名评价者确定数据并解决任何冲突。本系统评价按照PRISMA指南进行，并在Prospero上注册，标题为“调查术后24小时至1周内早期‘全身’（口服或静脉注射）类固醇给药在前路颈椎间盘切除融合术（ACDF）中的有效性：一项系统评价”。采用偏倚风险2.0（RoB 2.0）工具评估临床试验，采用纽卡斯尔-渥太华量表（NOS）评估回顾性研究。
纳入六项研究，结果显示静脉注射类固醇可有效减轻吞咽困难长达一个月，与术中使用的局部类固醇相比疗效更高。然而，静脉注射类固醇对椎旁肿胀的发生率没有显著影响。观察到声音嘶哑、疼痛评分和气道受压有所减轻，但其长期影响不显著。还发现全身类固醇在某些情况下会使融合延迟长达六个月，但对长期愈合和融合没有显著影响。
ACDF手术后围手术期使用静脉注射类固醇有助于减轻吞咽困难，与术中使用的局部类固醇的短暂效果相比，多次给药显示出长期有效性。患者在气道受压、疼痛和声音嘶哑方面可能会感觉到益处，且无明显全身并发症或融合失败。然而，关于最佳类固醇剂量、频率和剂型的证据有限，因此无法给出强有力的推荐。
