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J Neurol Surg A Cent Eur Neurosurg 2018; 79(02): 116-122
DOI: 10.1055/s-0037-1608824
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Lacking Benefit of Intraoperative High-Dose Dexamethasone in Instrumented Surgery for Cervical Spondylotic Myelopathy

Christian Blume
1   Department of Neurosurgery, University Hospital RWTH Aachen, Germany
,
Henrich Wiederhold
1   Department of Neurosurgery, University Hospital RWTH Aachen, Germany
,
Matthias Geiger
1   Department of Neurosurgery, University Hospital RWTH Aachen, Germany
,
Hans Clusmann
1   Department of Neurosurgery, University Hospital RWTH Aachen, Germany
,
Christian Andreas Müller
1   Department of Neurosurgery, University Hospital RWTH Aachen, Germany
› Author Affiliations
Further Information

Publication History

05 July 2017

08 September 2017

Publication Date:
14 December 2017 (online)

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Abstract

Background Our objective was to investigate the effect of intraoperative dexamethasone administration on wound healing, complications, and clinical outcome in patients with posterior surgery for cervical spondylotic myelopathy (CSM).

Methods We conducted a retrospective study of patients with CSM undergoing dorsal instrumentation and decompression of the cervical spine. The senior surgeon decided if administration of dexamethasone (40 mg intravenously) was indicated. Patients were divided into two groups: dexamethasone group (DG) and non-dexamethasone group (nDG). All patients were monitored for pre- and postoperative neurologic symptoms and complications. Clinical follow-up was evaluated with the Neck Disability Index (NDI) and the modified Japanese Orthopaedic Association (mJOA) score.

Results A total of 49 patients were included (DG, 25; nDG, 24). DG and nDG patients showed no significant differences in pre- and postoperative findings. Five patients in the DG had wound healing complications compared with patients in the nDG (p = 0.021), and one died due to infection. Apart from that, we did not observe any significant differences between the two groups regarding complications, neurologic symptoms, and follow-up (NDI and mJOA).

Conclusion Intraoperative dexamethasone administration had no influence on the postoperative outcome and follow-up. A significantly higher rate of wound infections was detected in the DG. These data support the hypothesis that intraoperative dexamethasone bolus application in CSM lacks benefit.

Keywords

cervical spondylotic myelopathy - wound healing - dorsal cervical fusion - high-dose dexamethasone
 

  • References

  • 1 Rhee JM, Shamji MF, Erwin WM. , et al. Nonoperative management of cervical myelopathy: a systematic review. Spine 2013; 38 (22) (Suppl. 01) S55-S67
    CrossrefPubMedGoogle Scholar
  • 2 Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine 2013; 38 (22) (Suppl. 01) S21-S36
    CrossrefPubMedGoogle Scholar
  • 3 Boogaarts HD, Bartels RH. Prevalence of cervical spondylotic myelopathy. Eur Spine J 2015; 24 (02) (Suppl. 02) 139-141
    CrossrefPubMedGoogle Scholar
  • 4 Tetreault LA, Karpova A, Fehlings MG. Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: results of a systematic review. Eur Spine J 2015; 24 (02) (Suppl. 02) 236-251
    CrossrefPubMedGoogle Scholar
  • 5 Tosato G, Jones KD. Interleukin-1 induces interleukin-6 production in peripheral blood monocytes. Blood 1990; 75 (06) 1305-1310
    CrossrefPubMedGoogle Scholar
  • 6 Tønnesen E, Wanscher M, Höhndorf K. , et al. Effect of methylprednisolone on the cytokine response in patients undergoing lung surgery. Acta Anaesthesiol Scand 1993; 37 (04) 410-414
    CrossrefPubMedGoogle Scholar
  • 7 Demura S, Takahashi K, Murakami H. , et al. The influence of steroid administration on systemic response in laminoplasty for cervical myelopathy. Arch Orthop Trauma Surg 2013; 133: 1041-1045
    CrossrefPubMedGoogle Scholar
  • 8 Rivkin A, Rivkin MA. Perioperative nonopioid agents for pain control in spinal surgery. Am J Health Syst Pharm 2014; 71 (21) 1845-1857
    CrossrefPubMedGoogle Scholar
  • 9 Vyvey M. Steroids as pain relief adjuvants. Can Fam Physician 2010; 56 (12) 1295-1297 , e415
    PubMedGoogle Scholar
  • 10 Yue WM, Tan SB. Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections. Spine 2003; 28 (11) E209-E211
    PubMedGoogle Scholar
  • 11 Smith RM, Schaefer MK, Kainer MA. , et al; Multistate Fungal Infection Outbreak Response Team. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med 2013; 369 (17) 1598-1609
    CrossrefPubMedGoogle Scholar
  • 12 Kainer MA, Reagan DR, Nguyen DB. , et al; Tennessee Fungal Meningitis Investigation Team. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med 2012; 367 (23) 2194-2203
    CrossrefPubMedGoogle Scholar
  • 13 Jalai CM, Worley N, Poorman GW, Cruz DL, Vira S, Passias PG. Surgical site infections following operative management of cervical spondylotic myelopathy: prevalence, predictors of occurrence, and influence on peri-operative outcomes. Eur Spine J 2016; 25 (06) 1891-1896
    CrossrefPubMedGoogle Scholar
  • 14 Floeth FW, Galldiks N, Eicker S. , et al. Hypermetabolism in 18F-FDG PET predicts favorable outcome following decompressive surgery in patients with degenerative cervical myelopathy. J Nucl Med 2013; 54 (09) 1577-1583
    CrossrefPubMedGoogle Scholar
  • 15 Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyglucose in turpentine-induced inflammatory tissue. J Nucl Med 1995; 36 (07) 1301-1306
    PubMedGoogle Scholar
  • 16 Brepoels L, Stroobants S, Vandenberghe P. , et al. Effect of corticosteroids on 18F-FDG uptake in tumor lesions after chemotherapy. J Nucl Med 2007; 48 (03) 390-397
    PubMedGoogle Scholar
  • 17 Naylor A, Flowers MW, Bramley JE. The value of dexamethasone in the postoperative treatment of lumbar disc prolapse. Orthop Clin North Am 1977; 8: 3-8
    PubMedGoogle Scholar
  • 18 Watters III WC, Temple AP, Granberry M. The use of dexamethasone in primary lumbar disc surgery. A prospective, randomized, double-blind study. Spine 1989; 14 (04) 440-442
    CrossrefPubMedGoogle Scholar
  • 19 King JS. Dexamethasone—a helpful adjunct in management after lumbar discectomy. Neurosurgery 1984; 14 (06) 697-700
    CrossrefPubMedGoogle Scholar
  • 20 Lundin A, Magnuson A, Axelsson K, Kogler H, Samuelsson L. The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery. Eur Spine J 2003; 12 (06) 625-630
    CrossrefPubMedGoogle Scholar
  • 21 Bednar DA, Wong A, Farrokhyar F, Paul J. Dexamethasone perioperative coanalgesia in lumbar spine fusion: a controlled cohort study of efficacy and safety. J Spinal Disord Tech 2015; 28 (07) E422-E426
    CrossrefPubMedGoogle Scholar
  • 22 Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14 (07) 409-415
    Google Scholar
  • 23 Bostelmann R. Skalen und Scores, Scores und Fragebögen, Neck Disability Index. In: Boern W, Meyer F. , eds. Spinale Neurochirurgie: Operatives Management von Wirbelsäulenerkranungen. Stuttgart, Germany: Schattauer; 2009: 435-436
    Google Scholar
  • 24 Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991; 4 (03) 286-295
    CrossrefPubMedGoogle Scholar
  • 25 Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy. Spine 2001; 26 (17) 1890-1894 ; discussion 1895
    CrossrefPubMedGoogle Scholar
  • 26 Herdmann J, Linzbach M, Krzan M, Dvorak J, Bock WJ. The European Myelopathy Score. In: Bauer BL, Brock M., Klinger M.. ed, Advances in Neurosurgery. Berlin: Springer; 1994: 266-268
    Google Scholar
  • 27 Karst M, Kegel T, Lukas A, Lüdemann W, Hussein S, Piepenbrock S. Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery 2003; 53 (02) 331-336 ; discussion 336–337
    CrossrefPubMedGoogle Scholar
  • 28 Aminmansour B, Khalili HA, Ahmadi J, Nourian M. Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain. Spine 2006; 31: 2415-2417
    CrossrefPubMedGoogle Scholar
  • 29 Wilson JR, Tetreault LA, Kim J. , et al. State of the art in degenerative cervical myelopathy: an update on current clinical evidence. Neurosurgery 2017; 80 (3S): S33-S45
    CrossrefPubMedGoogle Scholar
  • 30 Ghasemi M, Masaeli A, Rezvani M, Shaygannejad V, Golabchi K, Norouzi R. Oral prednisolone in the treatment of cervical radiculopathy: a randomized placebo controlled trial. J Res Med Sci 2013; 18 (Suppl. 01) S43-S46
    PubMedGoogle Scholar
  • 31 Jeyamohan SB, Kenning TJ, Petronis KA, Feustel PJ, Drazin D, DiRisio DJ. Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial. J Neurosurg Spine 2015; 23 (02) 137-143
    CrossrefPubMedGoogle Scholar
  • 32 Lad SP, Patil CG, Berta S, Santarelli JG, Ho C, Boakye M. National trends in spinal fusion for cervical spondylotic myelopathy. Surg Neurol 2009; 71 (01) 66-69 ; discussion 69
    CrossrefPubMedGoogle Scholar
  • 33 Boakye M, Patil CG, Santarelli J, Ho C, Tian W, Lad SP. Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery 2008; 62 (02) 455-461 ; discussion 461–462
    CrossrefPubMedGoogle Scholar
  • 34 Olsen MA, Mayfield J, Lauryssen C. , et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003; 98 (2, Suppl): 149-155
    PubMedGoogle Scholar
  • 35 McGirt MJ, Godil SS. Reduction of surgical site infection in spine surgery: an opportunity for quality improvement and cost reduction. Spine J 2013; 13 (09) 1030-1031
    CrossrefPubMedGoogle Scholar
  • 36 Radcliff KE, Neusner AD, Millhouse PW. , et al. What is new in the diagnosis and prevention of spine surgical site infections. Spine J 2015; 15 (02) 336-347
    CrossrefPubMedGoogle Scholar
  • 37 Patel AA, Zfass-Mendez M, Lebwohl NH. , et al. Minimally invasive versus open lumbar fusion: a comparison of blood loss, surgical complications, and hospital course. Iowa Orthop J 2015; 35: 130-134
    PubMedGoogle Scholar
  • 38 Croft LD, Pottinger JM, Chiang HY, Ziebold CS, Weinstein SL, Herwaldt LA. Risk factors for surgical site infections after pediatric spine operations. Spine 2015; 40 (02) E112-E119
    CrossrefPubMedGoogle Scholar
  • 39 Satake K, Kanemura T, Matsumoto A, Yamaguchi H, Ishikawa Y. Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients. Eur Spine J 2013; 22 (08) 1854-1858
    CrossrefPubMedGoogle Scholar
  • 40 Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2013; 110 (02) 191-200
    CrossrefPubMedGoogle Scholar
  • 41 Hofmeister EP, Dao KD, Glowacki KA, Shin AY. The role of midcarpal arthroscopy in the diagnosis of disorders of the wrist. J Hand Surg Am 2001; 26 (03) 407-414
    PubMedGoogle Scholar