title: Gastroesophageal reflux after anterior cervical surgery: a controlled, prospective analysis.
abstract: METHODS
  Prospective controlled clinical study.
  
  
  OBJECTIVE
  To determine the incidence and severity of GERD in patients undergoing anterior cervical decompression and fusion (ACDF), using patients undergoing posterior lumbar decompression as a control group.
  
  
  BACKGROUND
  The incidence gastroesophageal reflux disease (GERD) after anterior cervical decompression and fusion (ACDF) has not previously been studied.
  
  
  METHODS
  Patients undergoing either 1- or 2-level ACDF (n = 38) or posterior lumbar decompression surgery (control group, n = 56) were prospectively enrolled. Baseline patient characteristics were recorded. Intraoperative and postoperative medical records were reviewed. A validated GERD measurement tool (GERD Impact Scale, GIS) and a dysphagia questionnaire (including a dysphagia numeric rating score, range, 0-10) were administered preoperatively, and during the 2-week, 6-week, and 12-week postoperative visits.
  
  
  RESULTS
  Cervical patients had a significantly higher incidence of GERD at 2 weeks than the lumbar patients (78.9% vs. 42.9%, P = 0.001). Cervical patients had a higher incidence of GERD at 6 and 12 weeks as well, but these differences were not statistically significant. The change in GIS score from baseline was significantly higher in the cervical group at all follow-up time periods. On average, cervical patients required 1.2 doses of antacid medication in the postoperative period, compared to an average of 0.5 doses required by lumbar patients (P = 0.006). There was a significant correlation between the severity of dysphagia and the GIS score at 2 weeks, but no correlation at 6 or 12 weeks. Operative time did not correlate with the GIS score at any of the follow-up time periods. The number of surgical levels (i.e., one vs. two) and level of surgery (i.e., above C5-C6 vs. at or below C5-C6) had no effect on the GIS score.
  
  
  CONCLUSIONS
  Compared to the lumbar control group, patients in the cervical group had increased incidence, and severity of GERD-like symptoms in the early postoperative period.
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. jrihno16@yahoo.com
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rihn
authors.forename: Justin
authors.initials: J
authors.lastname: Kane
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: James
authors.initials: J
authors.lastname: Harrop
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D000863:Antacids