gms | German Medical Science

Objective: During dorsal spinal decompression and instrumentation we sometimes decide to inject a bolus of 20-40mg dexamethasone to reduce myelon edema and potentially prevent postoperative neurological deficits. However, there is no study data whether single administration of dexamethasone is safe and has an effect on neurological outcome. This study shows the characteristics of intraoperative dexamethasone admission during spinal cervical instrumentation in a single center consecutive series.

Method: We conducted a retrospective study on the short-term postoperative results of 59 patients undergoing dorsal decompression and instrumentation of the cervical spine in our department between 2008 and 2013. Data were extracted from patient charts and operation reports. Patients where monitored for preoperative symptoms, pre-existing medical conditions, postoperative neurological outcome and complications. Statistical analysis was performed with IBM SPSS software using exact Fisher-test and non-parametric Mann-Whitney-U Test.

Results: Out of the 59 patients 32 (54,2%) had received an intraoperative dexamethasone bolus versus 27 (45,8%) without dexamethasone boli. Dexamethasone was not routinely given in the postoperative period. Preoperative patient characteristics did not differ significantly between both groups in terms of age, sex, BMI, preexisting disease, and neurological deficit. Surgery associated complication occurred in 10 patients (31,3%) of the dexamethasone group and in 6 patients (22,2%) for the non-dexamethasone group (ns). However, out of these complications postoperative wound infections, independent of dose, occurred significantly more often in patients that had received intraoperative dexamethasone (n=6, 18,75% versus n=0; P= 0,03 using Fischer’s exact test). There was no statistical significance for postoperative neurological status (n=4, 12,5% in the dexamethasone group and n=6 22,2% in the non-dexamethasone group; P=0,49 using Fischer’s exact test).

Conclusions: In this series (i) intraoperative dexamethasone application did not improve neurological outcome but (ii) was associated with significant higher rates of wound infection. This data supports the hypothesis of missing benefit by dexamethasone, which is in line with findings from other medical conditions, but these findings should be proven in larger and prospectively studied cohorts.