Intraoperative Use of Topical Retropharyngeal Steroids for Dysphagia after Anterior Cervical Fusion: A Systematic Review and Meta-Analysis

PURPOSE: The anterior cervical approach is commonly used clinically for cervical spondylosis, but it also results in frequent postoperative dysphagia, which can increase the risk of complications and poor treatment satisfaction in severe cases. Intraoperative local application of retropharyngeal steroids has an impact on reducing the occurrence and severity of dysphagia; however, the results of current studies vary. The meta-analysis of this randomized trial was to evaluate the effectiveness and safety of intraoperative topical retropharyngeal steroids for the control of dysphagia after anterior cervical spine surgery. METHODS: Two authors searched electronic databases such as PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, respectively. The search terms were “Dysphagia,” “Steroids,” “Anterior Cervical Discectomy and Fusion,” etc. A random effects model was used to conduct a meta-analysis based on deviance information criteria. RESULTS: A total of 8 studies were included in this meta-analysis after screening of 792 studies. Bazaz scores were not significantly different in the steroid group at one day postoperatively (P = 0.38), and dysphagia was significantly improved at 14 days postoperatively (95% CI: 0.15 to 0.64; P = 0.002). PSTSI was significantly improved one day (P = 0.03) and 14 days after surgery (P < 0.0001). VAS scores were all lower versus controls (P < 0.001). CONCLUSION: Perioperative local retropharyngeal steroid administration as an adjunct to anterior cervical spine surgery reduces the incidence and severity of dysphagia compared with placebo control. However, future high-quality randomized controlled studies could incorporate nonsubjective dysphagia measures and long-term follow-up on the occurrence of associated complications or other side effects.