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)

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.