radiculopathy patients. Second, the outcomes of
CDA and ACDF were compared for myelopathy
patients (including myelopathy only and both
myelopathy and radiculopathy).
“Our results indicate that CDA brought similar
improvement for myelopathy and radiculopathy
patients,” said lead author Matthew Gornet, MD.
“Furthermore, myelopathy patients had fewer
serious adverse events after CDA than ACDF.
These results confirm the results of prior studies
but also demonstrate that the benefits of CDA
for the treatment of myelopathy are maintained
in the long term.”
Due to the small number of patients in the
study sample suffering from myelopathy exclu-
sive of radiculopathy, Dr. Gornet noted that the
benefits observed in this study are applicable to
patients who suffer predominantly from radicu-
lopathy with accompanying mild myelopathy.
Do Local Intraoperative Corticosteroids Delivered
in a Hemostatic-Matrix Minimize Dysphagia
Following Anterior Discectomy and Fusion (ACDF)? A
Preliminary Analysis of a Double Blinded Randomized
Controlled Trial (RCT)
Dan Stein, BS; Han Jo Kim, MD; Darren R. Lebl, MD; Russel C. Huang,
MD; Shari T. Jawetz, MD; Virginie Lafage, PhD; Todd J. Albert, MD
“In this study, we are investigating whether intraoperative
topical steroids are effective in decreasing the severity and/or
incidence of swallowing difficulty following multilevel anterior
cervical fusion surgery,” said Daniel Stein, BS.
A total of 59 patients were enrolled and randomized in a
double-blinded fashion. Arm S (Steroid) received 1 ml ( 40 mg)
of methylprednisolone delivered with an absorbable hemostatic matrix (vehicle) to the retro-esophageal space prior to
closure. The control arm (C) only received the vehicle prior
to closure. The SWAL-QOL, Eating Assessment Tool (EAT- 10),
and the Bazaz-Yoo Dysphagia Questionnaire (Bazaz) were
collected preoperatively, at postop day 1, at postop day 2 and
at one month postop.
Compared to a statistically similar baseline assessment of
swallowing, patients in the control arm had a greater change
in the median scores of particular subsections of the SWAL-QOL survey (at postop day 1, postop day 2 and at one month)
and EAT- 10 questionnaire (at postop day 1 and one month).
This represented a greater decline in their quality of life as
a result of an increased swallowing impairment. There was
no difference in Bazaz score between the two groups at any
time, and no significant difference in the rate of documented
complications in the perioperative time period.
“Our study shows promising early results that the application of local intraoperative corticosteroids can be used to
reduce dysphagia following ACDFs, without increasing early
postoperative complications,” Stein said.
The Effect of Local vs Intravenous Steroids on
Dysphagia and Dysphonia Following Anterior
Cervical Discectomy and Fusion (ACDF): A Single-
Blinded, Prospective, Randomized Control Trial
Tyler Jenkins, MD; Rueben Nair, MD; Surabhi Bhatt, BS; Brett D.
Rosenthal, MD; Jason W. Savage, MD; Wellington K. Hsu, MD; Alpesh
A. Patel, MD, FACS
“In this study, we aimed to determine the efficacy of intraoperative steroid administration — IV or local — on dysphagia
and dysphonia following ACDF,” said lead author Tyler Jenkins, MD.
A total of 75 patients undergoing ACDF for the treatment
of cervical degenerative disease were recruited and randomized into three cohorts: control (no steroid), IV steroid ( 10
mg one-time intraoperative dose of IV dexamethasone) or
local steroid groups ( 40 mg of triamcinolone placed in the
retropharyngeal space directly on the cervical plate). Primary
outcomes were measured for dysphagia and dysphonia. Secondary outcomes include Neck Disability Index (NDI) and
Visual Analog Scale (VAS) for neck pain. Patient outcomes
were collected preoperatively, and at postoperative day 1,
week 2, week 6 and 3 months.
“Based on our findings, severe dysphagia after ACDF appears to be a modifiable complication, with 40 mgs of local
triamcinolone yielding better patient-reported outcomes for
severe dysphagia compared with IV steroid and no steroid
administration,” Dr. Jenkins said. “Although ACDF is highly
successful surgery, there are still steps we as spine surgeons
can take to improve outcomes for our patients.”
Daniel Stein, BS
“Our study shows promising early
results that the application of local
intraoperative corticosteroids can be
used to reduce dysphagia following
ACDFs, without increasing early
Tyler Jenkins, MD
“Based on our findings, severe dysphagia after
ACDF appears to be a modifiable complication,
with 40 mgs of local triamcinolone yielding
better patient-reported outcomes for severe
dysphagia compared with IV steroid and no