The effect of local intraoperative corticosteroid application on postoperative dysphagia following anterior cervical spine surgery.

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local corticosteroid application on dysphagia, its safety and efficacy are still unclear. A systematic review was performed aiming to evaluate the evidence of local corticosteroid application in prevention or treatment of postoperative dysphagia following ACSS. A systematic search was performed in September 2018 in PubMed and Embase database. The following information was extracted: study investigator, year of publication, number of patients, study design, inclusion/exclusion criteria, administration protocol of steroid, type of surgical procedure, number of levels performed, assessment methodology of dysphagia, radiologic assessment of prevertebral soft tissue swelling (PSTS), follow-up time points, outcome of dysphagia, and corticosteroid-related complications. Qualitative synthesis was performed. Finally, 5 studies met the inclusion/exclusion criteria. Four studies found that local corticosteroid application could decrease the incidence and magnitude of postoperative dysphagia while 1 study showed no effect on dysphagia significantly at 6 weeks and 3 months follow-up time. A total of 2325 patients received local corticosteroid intraoperatively; no early corticosteroid-related complication was reported. Totally, 4 adverse events occurred in long-term follow-up time, including 2 bone nonunion at 1.5 and 2.5 years postoperatively, 2 esophageal perforation at 2 months and 11 months of follow-up, respectively. Local corticosteroid application can reduce the incidence and severity of dysphagia following ACSS without increasing early corticosteroid-related complications. But further high-quality study is necessary to analyze potential delayed complications.

Treatment of high-iliac-crest L5-S1 lumbar disc herniation via a transverse process endoscopic transforaminal approach.

OBJECTIVE: To investigate the clinical efficacy of transverse process endoscopic transforaminal discectomy for the treatment of high-iliac-crest L5-S1 lumbar disc herniation. METHODS: Seventeen patients with high-iliac-crest L5-S1 lumbar disc herniation who were treated with transforaminal endoscopy from April 2016 to January 2019 in the Department of Neurosurgery of Xuanwu Hospital were selected. The visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the efficacy of the procedure. RESULTS: All of the patients successfully underwent the surgical treatment. Sixteen patients (94.1 %) completed effective follow-up for more than 12 months. The VAS was 7.8 ±â€¯1.9, 2.9 ±â€¯1.6, 2.3 ±â€¯1.5 and 2.2 ±â€¯1.6 before surgery and at one day, 3 months, and the last follow-up after surgery, respectively. The ODI scores were 52.8 ±â€¯15.2 and 16.9 ±â€¯9.7 before surgery and 3 months after surgery, respectively, both of which were lower than before surgery (both P < 0.01). EFFICACY EVALUATION: An excellent outcome was achieved in 13 (81.3 %) patients, a good outcome in 1 patient (6.3 %), an acceptable outcome in 1 patient (6.3 %), and a poor outcome in 1 patient (6.3 %). CONCLUSIONS: The transverse process endoscopic transforaminal discectomy is a safe and effective surgical method for the treatment of high-iliac-crest L5-S1 lumbar disc herniation.