Key Radiographic Parameters That Influence the Improvement of Postoperative Gastroesophageal Reflux Disease in Patients Treated Surgically for Adult Spinal Deformity With a Minimum 2-Year Follow-up.
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Follow-Up Studies
Gastroesophageal Reflux
/ diagnostic imaging
Humans
Kyphosis
/ diagnostic imaging
Lumbar Vertebrae
/ diagnostic imaging
Male
Middle Aged
Postoperative Care
/ methods
Retrospective Studies
Spinal Fusion
/ methods
Surveys and Questionnaires
Thoracic Vertebrae
/ diagnostic imaging
Time Factors
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Aug 2020
01 Aug 2020
Historique:
entrez:
18
7
2020
pubmed:
18
7
2020
medline:
4
11
2020
Statut:
ppublish
Résumé
Retrospective observational study. The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD. Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown. Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained. Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD- group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery. GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective observational study.
OBJECTIVE
OBJECTIVE
The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown.
METHODS
METHODS
Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained.
RESULTS
RESULTS
Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD- group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery.
CONCLUSION
CONCLUSIONS
GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32675609
doi: 10.1097/BRS.0000000000003459
pii: 00007632-202008010-00013
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E943-E949Références
Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009; 34:E599–E606.
Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 2009; 34:785–791.
Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 2009; 34:1828–1833.
Yamato Y, Hasegawa T, Kobayashi S, et al. Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine (Phila Pa 1976) 2016; 41:E211–E217.
Acaroglu E, Yavuz AC, Guler UO, et al. A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden? Eur Spine J 2016; 25:2390–2400.
Zeng Y, Chen Z, Ma D, et al. The influence of kyphosis correction surgery on pulmonary function and thoracic volume. Spine (Phila Pa 1976) 2014; 39:1777–1784.
Bumpass DB, Lenke LG, Bridwell KH, et al. Pulmonary function improvement after vertebral column resection for severe spinal deformity. Spine (Phila Pa 1976) 2014; 39:587–595.
Yaszay B, Bastrom TP, Bartley CE, et al. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. Eur Spine J 2017; 26:1658–1664.
Hosogane N, Watanabe K, Yagi M, et al. Scoliosis is a risk factor for gastroesophageal reflux disease in adult spinal deformity. Clin Spine Surg 2017; 30:E480–E484.
Miyakoshi N, Kasukawa Y, Sasaki H, et al. Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis. Osteoporos Int 2009; 20:1193–1198.
Imagama S, Hasegawa Y, Wakao N, et al. Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people. Eur Spine J 2012; 21:2149–2157.
Yamaguchi T, Sugimoto T, Yamada H, et al. The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int 2002; 13:331–336.
Yamaguchi T, Sugimoto T, Yamauchi M, et al. Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women. J Bone Miner Metab 2005; 23:36–40.
Ohba T, Ebata S, Koyama K, et al. Prevalence and key radiographic spinal malalignment parameters that influence the risk for gastroesophageal reflux disease in patients treated surgically for adult spinal deformity. BMC Gastroenterol 2018; 18:8.
Sugimoto M, Hasegawa T, Nishino M, et al. Improvement of gastroesophageal reflux disease in Japanese patients with spinal kyphotic deformity who underwent surgical spinal correction. Dig Endosc 2016; 28:50–58.
Taneichi H. Update on pathology and surgical treatment for adult spinal deformity. J Orthop Sci 2016; 21:116–123.
Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005; 30:2024–2029.
Gum JL, Bridwell KH, Lenke LG, et al. SRS22R appearance domain correlates most with patient satisfaction after adult deformity surgery to the sacrum at 5-year follow-up. Spine (Phila Pa 1976) 2015; 40:1297–1302.
Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 2013; 38:E803–E812.
Ryan DJ, Protopsaltis TS, Ames CP, et al. T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 2014; 39:1203–1210.
Obeid I, Boissiere L, Yilgor C, et al. Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 2016; 25:3644–3649.
Kusano M, Shimoyama Y, Sugimoto S, et al. Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004; 39:888–891.
Watanabe T, Urita Y, Sugimoto M, et al. Gastroesophageal reflux disease symptoms are more common in general practice in Japan. World J Gastroenterol 2007; 13:4219–4223.
Hwang SW, Samdani AF, Stanton P, et al. Impact of pedicle screw fixation on loss of deformity correction in patients with adolescent idiopathic scoliosis. J Pediatr Orthop 2013; 33:377–382.
Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006; 31:291–298.
Oba H, Ebata S, Takahashi J, et al. Loss of pelvic incidence correction after long fusion using iliac screws for adult spinal deformity: cause and effect on clinical outcome. Spine (Phila Pa 1976) 2018; 44:195–202.
Banno T, Hasegawa T, Yamato Y, et al. Assessment of the change in alignment of fixed segment after adult spinal deformity surgery. Spine (Phila Pa 1976) 2018; 43:262–269.
Manometry and pH-metry in gastroesophageal reflux disease. Digest Dis Sci 1995; 40:2724–2730.