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Cervical Disc HerniationNCT02539394

Effect of Topical Corticosteroids on Dysphagia in Anterior Cervical Discectomy and Fusion

A study testing Methylprednisolone Acetate and Hemostatic Matrix Kit in people with Cervical Disc Herniation and Cervical Degenerative Disc Disease, run by Hospital for Special Surgery, New York.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine what effect intraoperative topical steroids have on reducing swallowing difficulty following Anterior Cervical Discectomy and Fusion surgery. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Methylprednisolone Acetate and Hemostatic Matrix Kit
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
128 participants
Where
No sites listed yet
Study dates
Aug 2015to 12 Nov 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Any patient > 18 years undergoing a 2-4 level Anterior Cervical Discectomy and Fusion

Who cannot join

  • Patients undergoing revision surgery
  • Pediatric patients
  • Trauma patients with cervical spine fractures
  • Patients with cancer
  • Patients with active infection
  • Patients with a known allergy to Methylprednisolone Acetate
  • Patients who refuse to participate
  • Non English speakers

About this study

Official title: Do Intraoperative Topical Corticosteroids Aid in the Prevention of Postoperative Dysphagia Following Elective Anterior Cervical Discectomy and Fusion? A Randomized, Controlled, Double Blinded Clinical Trial

The purpose of this study is to determine what effect intraoperative topical steroids have on reducing swallowing difficulty following Anterior Cervical Discectomy and Fusion surgery.

Read the detailed description

Background: Dysphagia is a serious post-operative concern in patients following anterior cervical surgery. Although many experts have acknowledged that dysphagia is often incompletely understood and defined, there is a significant amount of literature to support the significance of this clinical entity. This is the first randomized study to examine the use of topical steroids for the prevention of dysphagia postoperatively after anterior cervical discectomy and fusion.

Study Design: This study is a single site, double blinded randomized control trial. All individuals undergoing 2-4 level ACDF that meet the inclusion criteria will be randomized to either:

  1. treatment arm or
  2. control arm.

Both arms will undergo their planned surgeries and will receive the exact same procedure and standard of care as if they were not enrolled in a study. The only difference is that the treatment arm will receive 40 mg of Methylprednisolone Acetate delivered with one Hemostatic Matrix Kit injectable delivery vehicle prior to closure in the prevertebral soft tissues. The control group will receive only Hemostatic Matrix Kit prior to closure in the prevertebral soft tissues.

Outcomes: Patients will be asked to fill out questionnaires that assess dysphagia, general swallowing difficulty, and how neck pain impacts their quality of life. Additionally Radiographic images will be obtained at set time points to evaluate soft tissue inflammation and bony fusion.

Being tested
Methylprednisolone Acetate, Hemostatic Matrix Kit
Keywords
Anterior Cervical Discectomy and Fusion, Dysphagia, ACDF
Medical subject headings
Deglutition Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Methylprednisolone AcetateDrug

    Also called Depo-Medrol

    Methylprednisolone Acetate is a corticosteroid known to reduce swelling and inflammation.

  • Hemostatic Matrix KitOther

    Hemostatic Matrix Kits help prevent uncontrollable bleeding in a operative site during a procedure.

Study groups in NCT02539394
Study groupRoleWhat they receive
TreatmentExperimentalProcedure: Anterior Cervical Discectomy and Fusion. The treatment arm will receive 40 mg of Methylprednisolone Acetate delivered with a Hemostatic Matrix Kit prior to closure.
Receives: Drug: Methylprednisolone Acetate; Other: Hemostatic Matrix Kit
ControlPlacebo comparatorProcedure: Anterior Cervical Discectomy and Fusion. The control group will receive only a Hemostatic Matrix Kit prior to closure.
Receives: Other: Hemostatic Matrix Kit

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Degree of Dysphagia Patients Experience (Burden)

    SWAL-QOL survey - Burden domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  2. Degree of Dysphagia Patients Experience (Eating Desire)

    SWAL-QOL survey - Eating desire domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  3. Degree of Dysphagia Patients Experience (Eating Duration)

    SWAL-QOL survey - Eating duration domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  4. Degree of Dysphagia Patients Experience (Food Selection)

    SWAL-QOL survey - Food Selection domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  5. Degree of Dysphagia Patients Experience (Communication)

    SWAL-QOL survey - Communication domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  6. Degree of Dysphagia Patients Experience (Fear Swallow)

    SWAL-QOL survey - Fear swallow domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  7. Degree of Dysphagia Patients Experience (Social)

    SWAL-QOL survey - Social domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  8. Degree of Dysphagia Patients Experience (Mental)

    SWAL-QOL survey - Mental domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  9. Degree of Dysphagia Patients Experience (Sleep)

    SWAL-QOL survey - Sleep domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  10. Degree of Dysphagia Patients Experience (Fatigue)

    SWAL-QOL survey - Fatigue domain Score ranges between 0 and 100 (worst-best)

    Measured: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

Secondary outcomes (10)
  1. Patient Reported Swallowing Difficulty Over 1 Year

    The Eating Assessment Tool (EAT-10) is used to screen for self-perceived oropharyngeal dysphagia (OD) in community-dwelling elders. A summated EAT-10 total score ranges from 0 to 40, with a score ≥ 3 indicative of OD.

    Modified Eat-10 : Eat-10 questionnaire without questions 1 ("My swallowing problem has caused me to lose weight") and 2 ("My swallowing problem interferes with my ability to go out for meals") to be applicable during hospitalization.

    Eat-10 interpretation: Score ranging from 0 to 40 (best-worst)

    • each question response is 0-4, 0=no problem and 4=severe problem; score is a summation of each question's response Modified EAT-10 interpretation: Score ranging from 0 to 32 (best-worst)
    • each question response is 0-4, 0=no problem and 4=severe problem; score is a summation of each question's response

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  2. Patients' Bazaz Dysphagia Score - Liquid

    Bazaz dysphagia scale defines dysphagia as none, mild, moderate and severe, depending on patients' symptoms with solid and liquid foods.

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  3. Patients' Bazaz Dysphagia Score - Solid

    Bazaz dysphagia scale defines dysphagia as none, mild, moderate and severe, depending on patients' symptoms with solid and liquid foods.

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  4. Patients' Neck Disability

    Neck Disability Index (NDI) Range from 0 to 100 (best-worst)

    Measured: Pre-Op, Week 4-6, 3 Months, 6 Months, 12 Months

  5. Patients' Pain Scores on the Visual Analog Scale - Neck Pain

    Visual Analog Scale (VAS) - Neck pain Range from 0 to 100 (best-worst)

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  6. Patients' Pain Scores on the Visual Analog Scale - Left Arm Pain

    Visual Analog Scale (VAS) - Left arm pain Range from 0 to 100 (best-worst)

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  7. Patients' Pain Scores on the Visual Analog Scale - Right Arm Pain

    Visual Analog Scale (VAS) - Right arm pain Range from 0 to 100 (best-worst)

    Measured: Pre-Op, Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months

  8. Change in Pre-vertebral Soft Tissue Swelling Over 1 Year

    We are unable to report this outcome measure because soft tissue swelling was not assessed. The PI deemed it would not be included for this study as there is not a clinical or research standard to do so, nor is there normative data over time to compare against. Thus, data were not collected.

    Measured: Pre-Op, Post-Op Day 1, Week 4-6, 3 Months, 6 Months, 12 Months

  9. Fusion Rate

    1. Flex-Ex X-rays
    2. Bony bridging on a CT scan
    3. Obvious bony remodeling on lateral X-ray

    Measured: 12 Months

  10. Adverse Event

    Adverse Event (AE) following surgical treatment.

    Adverse event were classified by severity based on the AO-ISSG criteria and treatment required:

    Mild: Observed, medication, consult, X-ray. Essentially any management that was quick and easy and could be done at bedside Moderate: ICU admission, re-intubation, complication that had a documented prolonged hospital stay, medical procedure (such as flexible endoscopy), re-presentation to ED Severe: Inpatient re-admission, return to OR for any reason, mortality, failed OR.

    AE were also categorize as Surgery-site related or unrelated adverse event. Finally, AE were also categorize as potentially related to steroid use (example: leukocytosis, pseudoarthrosis, or wound complications)

    Measured: 12 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Sep 2015 (estimated)
  2. Study startAug 2015
  3. Primary completion12 Nov 2020
  4. Study completion12 Nov 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
128 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02539394
Sponsor's protocol ID
2014-145
Status last verified
Jun 2023
First submitted
27 Aug 2015
Last updated
10 Jul 2023
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Methylprednisolone Acetate and Hemostatic Matrix Kit in people with Cervical Disc Herniation and Cervical Degenerative Disc Disease, run by Hospital for Special Surgery, New York.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Jul 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Degree of Dysphagia Patients Experience (Burden) (time frame: Post-Op Day 1, Post-Op Day 2, Week 4-6, 3 Months, 6 Months, 12 Months). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jul 2023.

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