Objectives: Gastrointestinal complications are frequent after surgical correction of neuromuscular scoliosis, but the effects of scoliosis surgery on gastric function and upper gastrointestinal symptoms over the long term are unknown.
Methods: Thirty-one children (16 spastic, 15 flaccid patients) who underwent surgical correction of neuromuscular scoliosis were included in a prospective follow-up study. Median (range) age at surgery was 14.9 (5–20) years and follow-up time 4.3 (2–8) years. Electrogastrography (n = 28), gastric emptying scintigraphy (n = 17), and structured upper gastrointestinal symptoms questionnaire (n = 26) were evaluated before and after surgery. The results were related to patients’ clinical state, type and extent of corrective spinal surgery, and gastrointestinal complications.
Results: The median main scoliosis curve of 81 degrees (51–129 degrees) was corrected to 25 degrees (1.0–85 degrees) after surgery. In electrogastrogram, power ratio increased from preoperative 1.4 (0.30–11) to postoperative 6.2 (1.2–26) in the spastic group (P = 0.008), whereas in the flaccid group, power ratio remained unchanged at 2.2 (0.1–17). Patients with prolonged postoperative paralytic ileus had the most substantial increase in gastric power ratio (P = 0.038). Correction of sagittal spinal balance correlated with increased postprandial normogastric activity after surgery (R2 = 0.459; P = 0.004). The gastric emptying results, upper gastrointestinal symptoms, and body mass index were not significantly altered after scoliosis surgery.
Conclusions: Gastric myoelectrical power increased after surgical correction of spastic neuromuscular scoliosis and was associated with prolonged postoperative paralytic ileus. Correction of poor, stooped spinal balance improved gastric myoelectrical activity. The net effect of scoliosis surgery on gastric emptying, upper gastrointestinal symptoms, and clinical nutritional state was minimal.
*Section of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki
†Department of Pediatric Orthopedic Surgery, Turku University Central Hospital, Turku, Finland.
Address correspondence and reprint requests to Tuomas Jalanko, Messeniuksenkatu 10 B 19, 00250 Helsinki, Finland (e-mail: firstname.lastname@example.org).
Received 2 August, 2013
Accepted 2 August, 2013
T.J. has received grants from the Foundation for Pediatric Research, Rinnekoti Research Centre, Research Foundation for Orthopaedics and Traumatology, Turku University Central Hospital, and Medtronic International. I.H. has received grants form Turku University Central Hospital and Medtronic International and is a consultant for Medtronic International.
The authors report no conflicts of interest.