{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:52:08Z","timestamp":1792219928954,"version":"4.4.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T00:00:00Z","timestamp":1667260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82172522"],"award-info":[{"award-number":["82172522"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010822","name":"Chengdu Science and Technology Program","doi-asserted-by":"publisher","award":["2021-YF05-00436-SN"],"award-info":[{"award-number":["2021-YF05-00436-SN"]}],"id":[{"id":"10.13039\/501100010822","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To conduct a high-level meta-analysis of the RCTs to evaluate perioperative steroids use in the management of fusion rate, dysphagia, and VAS following anterior cervical spine surgery for up to 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the database PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, Ovid, and <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link> without time restriction to identify RCTs that evaluate the effectiveness of perioperative steroids after anterior cervical spine surgery. A subgroup analysis was undertaken to investigate the effects of intravenous and local steroids. This study was registered in the PROSPERO database prior to initiation (CRD42022313444).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 14 RCTs were eligible for final inclusion. This meta-analysis showed that steroids could achieve lower dysphagia rate (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), severe dysphagia rate within 1 year (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), lower VAS scores at both 1 day (<jats:italic>p<\/jats:italic>\u2009=\u20090.005), 2 weeks (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and shorter hospital stay (<jats:italic>p<\/jats:italic>\u2009=\u20090.014). However, there was no significant difference between the two groups regarding operation time (<jats:italic>p<\/jats:italic>\u2009=\u20090.670), fusion rates (<jats:italic>p<\/jats:italic>\u2009=\u20090.678), VAS scores at 6 months (<jats:italic>p<\/jats:italic>\u2009=\u20090.104) and 1 year (<jats:italic>p<\/jats:italic>\u2009=\u20090.062). There was no significant difference between intravenous and local steroid administration regarding dysphagia rates (<jats:italic>p<\/jats:italic>\u2009=\u20090.82), fusion rate (<jats:italic>p<\/jats:italic>\u2009=\u20091.00), and operative time (<jats:italic>p<\/jats:italic>\u2009=\u20090.10).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Steroids intravenously or locally following anterior cervical spine surgery can reduce incidence and severity of dysphagia within 1 year, VAS score within 2 weeks, and shorten the length of hospital stay without affecting fusion rates, increasing the operating time, VAS score at 6 months and 1 year.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.1040166","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T05:12:50Z","timestamp":1667279570000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of perioperative steroids application on dysphagia, fusion rate, and visual analogue scale (VAS) following anterior cervical spine surgery: A meta-analysis of 14 randomized controlled trials (RCTs)"],"prefix":"10.3389","volume":"9","author":[{"given":"Xiang","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Wei","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke-Rui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Tai","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"602","DOI":"10.3171\/jns.1958.15.6.0602","article-title":"The anterior approach for removal of ruptured cervical disks","volume":"15","author":"Cloward","year":"1958","journal-title":"J Neurosurg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"607","DOI":"10.2106\/00004623-195840030-00009","article-title":"The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion","author":"Smith","year":"1958","journal-title":"J Bone Joint Surg Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2310","DOI":"10.1097\/BRS.0b013e318154c57e","article-title":"Anterior cervical discectomy and fusion associated complications","volume":"32","author":"Fountas","year":"2007","journal-title":"Spine"},{"key":"B4","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1097\/00024720-200210000-00004","article-title":"Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment","volume":"15","author":"Frempong-Boadu","year":"2002","journal-title":"J Spinal Disord Tech"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e400","DOI":"10.1097\/BRS.0000000000002865","article-title":"Predictive factors of postoperative dysphagia in single-level anterior cervical discectomy and fusion","volume":"44","author":"Vaishnav","year":"2019","journal-title":"Spine"},{"key":"B6","doi-asserted-by":"publisher","first-page":"444","DOI":"10.21037\/jss.2017.08.03","article-title":"Anterior cervical spine surgery-associated complications in a retrospective case-control study","volume":"3","author":"Tasiou","year":"2017","journal-title":"J Spine Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s00455-013-9482-9","article-title":"Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery","volume":"29","author":"Starmer","year":"2014","journal-title":"Dysphagia"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1097\/01.brs.0000186317.86379.02","article-title":"Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study","volume":"30","author":"Riley","year":"2005","journal-title":"Spine"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1097\/00007632-200211150-00007","article-title":"Incidence of dysphagia after anterior cervical spine surgery: a prospective study","volume":"27","author":"Bazaz","year":"2002","journal-title":"Spine"},{"key":"B10","doi-asserted-by":"publisher","first-page":"176","DOI":"10.3171\/spi.2002.97.2.0176","article-title":"Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery","volume":"97","author":"Ratnaraj","year":"2002","journal-title":"J Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1097\/BRS.0b013e318158dec8","article-title":"Role of plate thickness as a cause of dysphagia after anterior cervical fusion","volume":"32","author":"Chin","year":"2007","journal-title":"Spine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.spinee.2019.08.018","article-title":"Effect of local retropharyngeal steroids on fusion rate after anterior cervical discectomy and fusion","volume":"20","author":"Gandhi","year":"2020","journal-title":"Spine J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"E530","DOI":"10.1097\/BRS.0000000000001293","article-title":"Retropharyngeal steroids and dysphagia following multilevel anterior cervical surgery","volume":"41","author":"Koreckij","year":"2016","journal-title":"Spine"},{"key":"B14","doi-asserted-by":"publisher","first-page":"656","DOI":"10.31616\/asj.2018.12.4.656","article-title":"Effect of steroid-soaked gelatin sponge on soft tissue swelling following anterior cervical discectomy and fusion: a radiographic analysis","volume":"12","author":"Schroeder","year":"2018","journal-title":"Asian Spine J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1097\/BRS.0000000000001407","article-title":"The effect of local intraoperative steroid administration on the rate of postoperative dysphagia following ACDF: a study of 245,754 patients","volume":"41","author":"Cancienne","year":"2016","journal-title":"Spine"},{"key":"B16","first-page":"211","article-title":"Effect of intravenous dexamethasone on prevertebral soft tissue swelling after anterior cervical discectomy and fusion","volume":"79","author":"Nam","year":"2013","journal-title":"Acta Orthop Belg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2143","DOI":"10.1097\/BRS.0000000000000636","article-title":"The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients","volume":"39","author":"van Eck","year":"2014","journal-title":"Spine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2286","DOI":"10.1097\/BRS.0b013e318237e5d0","article-title":"Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study","volume":"36","author":"Lee","year":"2011","journal-title":"Spine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"Br Med J"},{"key":"B20","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.3","author":"Higgins","year":"2022"},{"key":"B21","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Br Med J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.2106\/JBJS.19.00198","article-title":"The effects of perioperative corticosteroids on dysphagia following surgical procedures involving the anterior cervical spine: a prospective, randomized, controlled, double-blinded clinical trial","volume":"101","author":"Cui","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/2192568220925782","article-title":"Prospective randomized controlled trial to study the effect of local steroids in the retropharyngeal space after anterior cervical discectomy and fusion","author":"Dahapute","year":"","journal-title":"Global Spine J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/BRS.0000000000001284","article-title":"Can dysphagia following anterior cervical fusions with rhBMP-2 be reduced with local depomedrol application? A prospective, randomized, placebo-controlled, double-blind trial","volume":"41","author":"Edwards","year":"2016","journal-title":"Spine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e1176","DOI":"10.1016\/j.wneu.2019.01.273","article-title":"Dysphagia prevention in anterior cervical discectomy surgery: results from a prospective clinical study","volume":"125","author":"Grasso","year":"2019","journal-title":"World Neurosurg"},{"key":"B26","first-page":"7","article-title":"The effect of local steroid injection on prevertebral soft tissue swelling after anterior cervical discectomy and fusion","volume":"18","author":"Hasani","year":"2016","journal-title":"J Babol Univ Medical Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3171\/2017.11.SPINE17819","article-title":"Impact of local steroid application on dysphagia following an anterior cervical discectomy and fusion: results of a prospective, randomized single-blind trial","volume":"29","author":"Haws","year":"2018","journal-title":"J Neurosurg Spine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.2106\/JBJS.17.01540","article-title":"The effect of local versus intravenous corticosteroids on the likelihood of dysphagia and dysphonia following anterior cervical discectomy and fusion: a single-blinded, prospective, randomized controlled trial","volume":"100","author":"Jenkins","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"B29","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3171\/2014.12.SPINE14477","article-title":"Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial","volume":"23","author":"Jeyamohan","year":"2015","journal-title":"J Neurosurg Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/BRS.0000000000003825","article-title":"Effect of topical steroid on swallowing following ACDF results of a prospective double-blind randomized control trial","volume":"46","author":"Kim","year":"2021","journal-title":"Spine"},{"key":"B31","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s00586-002-0495-6","article-title":"Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone","volume":"12","author":"Pedram","year":"2003","journal-title":"Eur Spine J"},{"key":"B32","doi-asserted-by":"publisher","first-page":"84","DOI":"10.22037\/icnj.v4i3.18461","article-title":"Effect of local steroid injection on prevertebral soft tissue swelling following anterior cervical discectomy and fusion","volume":"4","author":"Seddighi","year":"2017","journal-title":"Int Clin Neurosci J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2954","DOI":"10.1016\/j.spinee.2014.06.005","article-title":"The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis","volume":"14","author":"Song","year":"2014","journal-title":"Spine J"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.2106\/00004623-199309000-00005","article-title":"Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients","volume":"75","author":"Bohlman","year":"1993","journal-title":"J Bone Joint Surg Am"},{"key":"B35","doi-asserted-by":"publisher","first-page":"941","DOI":"10.2106\/00004623-199807000-00002","article-title":"Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up","volume":"80","author":"Emery","year":"1998","journal-title":"J Bone Joint Surg Am"},{"key":"B36","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s00586-021-06727-1","article-title":"The retropharyngeal steroid use during operation on the fusion rate and dysphagia after ACDF? A systematic review and meta-analysis","volume":"31","author":"Song","year":"2022","journal-title":"Eur Spine J"},{"key":"B37","doi-asserted-by":"publisher","first-page":"821","DOI":"10.2106\/JBJS.20.01756","article-title":"Perioperative corticosteroids reduce dysphagia severity following anterior cervical spinal fusion: a meta-analysis of randomized controlled trials","volume":"103","author":"Garcia","year":"2021","journal-title":"J Bone Joint Surg Am"},{"key":"B38","doi-asserted-by":"publisher","first-page":"7115254","DOI":"10.1155\/2021\/7115254","article-title":"Intraoperative use of topical retropharyngeal steroids for dysphagia after anterior cervical fusion: a systematic review and meta-analysis","volume":"2021","author":"Yu","year":"2021","journal-title":"Dis Markers"},{"key":"B39","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1177\/2192568217708776","article-title":"Corticosteroid administration to prevent complications of anterior cervical spine fusion: a systematic review","volume":"8","author":"Zadegan","year":"2018","journal-title":"Global Spine J"},{"key":"B40","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s10143-019-01207-z","article-title":"The effect of local intraoperative corticosteroid application on postoperative dysphagia following anterior cervical spine surgery","volume":"45","author":"Cheng","year":"2022","journal-title":"Neurosurg Rev"},{"key":"B41","doi-asserted-by":"publisher","first-page":"9","DOI":"10.14444\/4009","article-title":"Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: a systematic review","volume":"11","author":"Adenikinju","year":"2017","journal-title":"Int J Spine Surg"},{"key":"B42","first-page":"277","article-title":"Steroids, retinoids, and wound healing","volume":"11","author":"Anstead","year":"1998","journal-title":"Adv Wound Care"},{"key":"B43","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s11420-006-9012-5","article-title":"Perioperative management of medications used in the treatment of rheumatoid arthritis","volume":"2","author":"Scanzello","year":"2006","journal-title":"HSS J"},{"key":"B44","doi-asserted-by":"publisher","first-page":"285","DOI":"10.3171\/2016.1.SPINE15898","article-title":"Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature","volume":"25","author":"Halani","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e75","DOI":"10.1016\/j.spinee.2015.06.058","article-title":"Delayed esophageal perforation after anterior cervical fusion and retropharyngeal steroid use: a report of two cases","volume":"15","author":"Lee","year":"2015","journal-title":"Spine J"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1040166\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T05:12:59Z","timestamp":1667279579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1040166\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,1]]},"references-count":45,"alternative-id":["10.3389\/fsurg.2022.1040166"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.1040166","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,1]]},"article-number":"1040166"}}