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Randomized Controlled Trial
. 2024 Dec 4;106(23):2241-2248.
doi: 10.2106/JBJS.24.00084. Epub 2024 Oct 23.

Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion: A Study Using High-Resolution Impedance Manometry

Chih-Jun Lai  1   2 , Jo-Yu Chen  3   4 , Jing-Rong Jhuang  5 , Ming-Yen Hsiao  6   7 , Tyng-Guey Wang  6   7 , Yu-Chang Yeh  2   8 , Dar-Ming Lai  9   10 , Fon-Yih Tsuang  9   10   11
Affiliations
Randomized Controlled Trial

Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion: A Study Using High-Resolution Impedance Manometry

Chih-Jun Lai et al. J Bone Joint Surg Am. .

Abstract

Background: The aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the effects on key swallowing muscles, including the upper esophageal sphincter (UES).

Methods: We randomly assigned patients undergoing ACDF to either the corticosteroid group or the saline solution group. Patients received 10 mg of local triamcinolone or saline solution prevertebrally at the cervical spine level before wound closure. Swallowing function preoperatively and at 1 month postoperatively were compared between the groups with use of HRIM parameters (e.g., UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contraction) and EAT-10 scores. Patients were also followed for postoperative complications and mortality within 12 months after surgery.

Results: Thirty patients completed the study. The median age was 55 years in the corticosteroid group and 57 years in the saline group, and each group had 8 female patients. All participants were Taiwanese. We found no significant difference in median preoperative UES relaxation pressure between the corticosteroid and saline solution groups (33.8 and 31.3 mm Hg, respectively; p = 0.54). Postoperatively, the corticosteroid group had significantly lower median UES relaxation pressure than the saline solution group (24.5 versus 33.6 mm Hg; p = 0.01). Before and after surgery, all other HRIM parameters and EAT-10 scores were similar between the groups, with the corticosteroid group demonstrating median pre- and postoperative EAT-10 scores of 0 and 4, respectively, and the saline solution group demonstrating scores of 2 and 3, respectively. There were no adverse events.

Conclusions: The findings suggest that local corticosteroids may reduce UES relaxation pressure at 1 month after ACDF, potentially enhancing UES opening. Further research is required to verify our findings.

Level of evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: This study was funded by National Taiwan University Hospital (110-32). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I247 ).

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment and analysis in accordance with the Consolidated Standards Of Reporting Trials.
Fig. 2
Fig. 2
Images showing the high-resolution impedance manometry (HRIM) catheter, plate, and fluid bolus in the body. “A” indicates the HRIM catheter from the pharynx to the esophagus. “B” indicates the cervical plate in the retropharyngeal and prevertebral spaces. “C” indicates the fluid bolus passing from the pharynx into the esophagus.
See this image and copyright information in PMC

References

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