Abstract
BackgroundGastroesophageal reflux disease (GERD) is a factor that has a significant negative impact on the quality of life (QoL). Vertebral fractures and/or spinal malalignment may influence the frequency of GERD. However, the epidemiology and pathology of GERD in patients with adult spinal deformity (ASD) are still largely unknown. To establish the optimal surgical strategy for GERD in patients treated surgically for ASD, we sought to clarify the GERD prevalence, determine radiographically which spinal malalignment parameters influence GERD risk, and evaluate GERD improvement postoperatively.MethodsSeventy-one consecutive patients with ASD who were treated with thoracolumbar corrective surgery and followed up for at least 1 year were enrolled. GERD was diagnosed by a gastroenterologist based on proton pump inhibitor medication response and/or an FSSG score > 8 points. Full-length lateral radiographs in a standing posture and in a supine, fulcrum backward-bending (FBB) position were taken preoperatively and 1 year postoperatively, and radiographic parameters were obtained. Correlations between radiographic parameters and FSSG scores were determined by Pearson’s correlation coefficient. Multivariate logistic regression analyses were performed to evaluate the odds ratio (OR) with a 95% confidence interval (95% CI) for potential risk factors for GERD.ResultsPatients were classified into two groups based on GERD symptoms, with 37 (52%) in the GERD+ group. Thoracolumbar kyphosis (TLK) in the FBB position was significantly more common in the GERD+ versus the GERD− group. Multivariate logistic regression analysis showed that lumbar lordosis (LL) and TLK curve in the FBB position significantly influenced the presence of GERD. Other factors showed no association with GERD. Significant improvements in FSSG scores were noted 1 year postoperatively. However, 20 (28.2%) patients still had GERD symptoms. The postoperative TLK curve was highly significantly correlated with FSSG scores 1 year postsurgery.ConclusionsOf the 71 patients treated surgically for ASD, 37 (52%) had a high frequency of GERD symptoms. An inflexible thoracolumbar curve with increased TLK in the FBB position was significantly associated with GERD symptoms. Despite significant improvements in FSSG scores postoperatively, insufficient correction of TLK might be a risk factor for persistent GERD symptoms.
Highlights
Gastroesophageal reflux disease (GERD) is a factor that has a significant negative impact on the quality of life (QoL)
The inclusion criteria were age greater than 60 years and a radiographic diagnosis of adult spinal deformity (ASD) defined by at least one of the following parameters: a coronal Cobb angle more than 30°; a C7 sagittal vertical axis (SVA), which is the distance between the C7 plumb line and the posterosuperior edge of S1, more than 5 cm; pelvic tilt (PT), which is the orientation of the pelvis with respect to the femurs and the rest of the body, more than 25°; and/or thoracic kyphosis (TK) more than 30°
There were no significant differences between the groups for any of the sagittal spine radiographic parameters measured in a standing position
Summary
Gastroesophageal reflux disease (GERD) is a factor that has a significant negative impact on the quality of life (QoL). The epidemiology and pathology of GERD in patients with adult spinal deformity (ASD) are still largely unknown. To establish the optimal surgical strategy for GERD in patients treated surgically for ASD, we sought to clarify the GERD prevalence, determine radiographically which spinal malalignment parameters influence GERD risk, and evaluate GERD improvement postoperatively. Gastroesophageal reflux disease (GERD) is recognized as a factor that has a significant negative impact on quality of life (QoL) [8], and a recent large survey showed that 37.6% of Japanese individuals were affected by GERD [9]. To establish the optimal surgical strategy for treating GERD in patients with ASD, we set out to do the following: 1) to clarify the prevalence of GERD; 2) to determine radiographically which spinal malalignment parameters predominantly influence the risk for GERD; and 3) to evaluate the improvement of GERD after surgical spinal correction
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