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The Effect of High-Dose Corticosteroids on Cervical Spinal FusionA Report of Two Cases
Kingsley R. Chin, MD1; Jason Seale, MBBS1; Vanessa Cumming, MBBS2
1 Institute for Modern & Innovative Surgery, 1100 West Oakland Park Boulevard, Suite 3, Fort Lauderdale, FL 33311. E-mail address for K.R. Chin: Kingsleychin@imissurgery.com
2 Less Exposure Surgery (LES) Society, 300 East Oakland Park Boulevard, Suite 502, Fort Lauderdale, FL 33334
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Investigation performed at the Institute for Modern & Innovative Surgery and the Less Exposure Surgery (LES) Society, Fort Lauderdale, Florida

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jan 09;3(1):e4 1-4. doi: 10.2106/JBJS.CC.L.00024
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The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) have been implicated as a risk factor for nonunion after spinal fusion in both animal and human models1-6, but there remains debate about the real risk of NSAIDs with spinal fusion because prospective, randomized trials are still insufficient for robust meta-analysis7. Diclofenac sodium has a dose-dependent inhibitory effect on spinal fusion, especially in the immediate postoperative period, that is independent of smoking history, age, sex, and levels of vertebrae that have been fused2. Perioperative corticosteroids and their anti-inflammatory properties may improve the outcomes (e.g., length of hospital stay and time to return to full-time work) of microscopic disc surgical procedures, and may reduce pain and improve the functional outcome of these procedures8. Postoperative use of high-dose intravenous (IV) corticosteroids (at least 30 mg/kg of body weight of methylprednisolone or equivalent corticosteroid preparations per kg of body weight) have potent anti-inflammatory effects and may be useful in cases of acute spinal cord injury9-12, despite major dose-related side effects and relatively modest improvements in neurological function. Conversely, prolonged systemic administration of corticosteroids may induce osteoporosis and delayed fracture-healing13-15, and may suppress natural corticosteroid (adrenocorticotropic hormone) secretion. The effects of corticosteroids on spinal fusion and bone remodeling are not yet well documented in the literature16.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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