Effect of intravenous dexamethasone on prevertebral soft tissue swelling after anterior cervical discectomy and fusion.

The authors compared the effect of postoperative administration of corticosteroids (dexamethasone) on prevertebral soft tissue swelling with that of placebo in patients with anterior cervical discectomy and fusion (ACDF). Sixty-two consecutive patients with degenerative disc disease of the cervical spine, who underwent a one level ACDF, were examined prospectively. They were assigned randomly to 3 treatment groups. Group 1 received 10/5/5 mg, immediately postoperatively and on day 1 and 2, group 2 received 20/10/10 mg, and group 3 received placebo (normal saline). Plain lateral radiographs in the supine position were taken preoperatively, immediately postoperatively, and then daily for 5 days after the operation. The area of the prevertebral soft tissue density was measured from the lower border of C1 to the upper end plate of C7 on the lateral radiographs, using a PACS digital measuring instrument. The patients were also asked to evaluate dyspnea and dysphagia, using a 10-point visual analog scale (VAS). The 3 groups did not differ statistically with regard to the area of prevertebral soft tissue density and VAS for dysphagia, at any time. However, group 1 and 2 showed significant reduction in VAS for dyspnea, compared to group 3, immediately postoperatively, on day 1 and day 2. Group 1 and 2 showed no significant difference of VAS for dyspnea on any postoperative day, suggesting that the dose played no role. As a conclusion, steroids are not effective in reducing postoperative prevertebral soft tissue density, but might reduce initial dyspnea.