Gastroesophageal reflux after anterior cervical surgery: a controlled, prospective analysis

Prospective controlled clinical study.

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.

The incidence gastroesophageal reflux disease (GERD) after anterior cervical decompression and fusion (ACDF) has not previously been studied.

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.

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.

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.