158 Dexamethasone's Effect in Multiple-Level Anterior Cervical Discectomy and Fusion

INTRODUCTION:Patients with cervical myelopathy require decompressive procedures with fusion to relieve pressure on the cervical cord to prevent further functional loss. In long-segment constructs performed anteriorly, airway edema and impaired swallowing are commonly treated with steroid medication; this is believed to affect fusion rates. This study prospectively analyzes dexamethasoneʼs effects on swallowing and fusion. METHODS:A prospective, placebo-controlled, double-blinded, randomized study examining dexamethasoneʼs effect in anterior cervical procedures was performed from 2008 to 2013. Patients included had anterior decompression and fusion ≥ 3 levels for myelopathy. Data collected included fusion rates, pertinent complications, swallowing function, mJOA, visual analogue score, SF-12, and Oswestry Disability Index (ODI). Fusion was assessed by CT at 6 months and 1 year. RESULTS:Sixty-one patients followed for 1 year were identified. 33 were randomized to dexamethasone, and 28 to saline. Two patients required postoperative intubation for airway edema, both of whom received placebo. Two patients required readmission within a week for severe dysphagia, and 1 for development of a DVT. For both groups, mJOA remained stable, whereas axial pain and ODI improved; administration of dexamethasone proved insignificant. In the placebo group, fusion rates were 61.5% at 6 months and 76.9% at 1 year. In the dexamethasone group, fusion rates were 33.3% at 6 months and 73.3% at 1 year, which proved significant at 6 months but not 1 year. Swallowing function (FOSS) was significantly better in the dexamethasone group at 2 weeks and 1 month. Length of stay was significantly shorter in the dexamethasone group when compared to placebo (2.5 vs 4.7 days). CONCLUSION:Multilevel anterior cervical discectomy and fusion is a reasonable operation for cervical myelopathy with minimal airway risks. Dexamethasone administration is safe to improve swallowing and control neck edema postoperatively to 1 month. It significantly decreases length of stay. It reduces fusion rates at 6 months, though not at 1 year.