The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation Analysis of the Spine Patient Outcomes Research Trial (SPORT)
Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation.
An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disc herniation. A comparison was made between patients with a body mass index of <30 kg/m² (nonobese) (n = 854) and those with a body mass index of ≥30 kg/m² (obese) (n = 336). Baseline patient demographic and clinical characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to four years. The difference in improvement from baseline between operative and nonoperative treatment was determined at each follow-up period for both groups.
At the time of the four-year follow-up evaluation, improvements over baseline in primary outcome measures were significantly less for obese patients as compared with nonobese patients in both the operative treatment group (Short Form-36 physical function, 37.3 compared with 47.7 points [p < 0.001], Short Form-36 bodily pain, 44.2 compared with 50.0 points [p = 0.005], and Oswestry Disability Index, -33.7 compared with -40.1 points [p < 0.001]) and the nonoperative treatment group (Short Form-36 physical function, 23.1 compared with 32.0 points [p < 0.001] and Oswestry Disability Index, -21.4 compared with -26.1 points [p < 0.001]). The one exception was that the change from baseline in terms of the Short Form-36 bodily pain score was statistically similar for obese and nonobese patients in the nonoperative treatment group (30.9 compared with 33.4 points [p = 0.39]). At the time of the four-year follow-up evaluation, when compared with nonobese patients who had been managed operatively, obese patients who had been managed operatively had significantly less improvement in the Sciatica Bothersomeness Index and the Low Back Pain Bothersomeness Index, but had no significant difference in patient satisfaction or self-rated improvement. In the present study, 77.5% of obese patients and 86.9% of nonobese patients who had been managed operatively were working a full or part-time job. No significant differences were observed in the secondary outcome measures between obese and nonobese patients who had been managed nonoperatively. The benefit of surgery over nonoperative treatment was not affected by body mass index.
Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients.
Available from: Ki-Jeong Kim
- "A previous study comparing perioperative findings between obese and nonobese patients undergoing lumbar spine surgery demonstrated no difference in operation time, EBL, or length of hospital day1). But, other study by Jeffrey et al. demonstrated that obesity leads to increased operation time, EBL, and length of hospital day8). "
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The purpose of this study was to evaluate the effect of patients' bod mass index (BMI) on surgical outcomes following one-level lumbar microdiscectomy.
From June 2003 to March 2007, 129 patients underwent one-level lumbar microdiscectomy performed at a single institution. We divided the patients into 3 groups, depending on BMI. A retrospective study was conducted among the 3 groups. The operation time, estimated blood loss (EBL), postoperative hospital day, recurrent disc herniation, intraoperative durotomy, and postoperative epidural steroid injection were analyzed. Regression models were used to predict the relationship between BMI and surgical outcomes including operation time and EBL.
As BMI is greater, as the operation time is longer and the EBL is more. In particular, linear regression model analysis implied that 2.35 minute in the operation time is longer and 8.89cc in EBL is more, as BMI of 1 kg/m2 is increased. No statistically relevant differences were observed for postoperative hospital day, recurrent disc herniation, intraoperative durotomy, and postoperative epidural steroid injection.
The operation time and EBL was significantly increased in obesity, but there were no differences in surgical outcomes. Our results demonstrated that higher BMI are not likely to encounter heightened morbidity in lumbar microdiscectomy.
06/2014; 11(2):68-73. DOI:10.14245/kjs.2014.11.2.68
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ABSTRACT: STUDY DESIGN:: Prospective comparative cohort study. OBJECTIVE:: Investigate whether there is a difference in post-operative pain reduction, complication rate and other markers of operative difficulty in obese and non-obese patients undergoing elective lumbar microdiscectomy by a single spinal surgeon. SUMMARY OF BACKGROUND DATA:: Lumbar radiculopathy is a debilitating condition that affects obese and non-obese patients. There is reluctance amongst some surgeons to perform lumbar microdiscectomy in the obese population. METHODS:: Over 3 years a group of 34 obese patients were compared to 34 non-obese patients from the same period. Operative duration, blood loss, unintentional durotomies, infection rate, hospital stay and pain reduction were compared. RESULTS:: Reduction in total pain (control -82-5;; obese -71%) and radicular leg pain (control -98%; obese -97%) were similar. The risk of superficial infections was greater in the obese group, but there was no difference in rate of serious complication in our small series. Operative duration was much longer in the obese group (control 28 min; obese 70 min), as was total hospital stay. CONCLUSIONS:: We found good post-operative pain relief in both groups. There was no difference in radicular leg pain between obese and non-obese patients but total pain due to lumbago was greater pre-operatively and post-operatively in the obese group making their total pain greater. There was no evidence of higher serious complication rate that would preclude offering operative lumbar microdiscectomy to obese patients due to their obesity alone. However, operative duration was significantly longer in obese patients and should be considered accordingly.
Journal of spinal disorders & techniques 04/2013; 28(6). DOI:10.1097/BSD.0b013e318290bf4a · 2.20 Impact Factor
Available from: Jeffrey Lotz
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ABSTRACT: Low back pain (LBP) is the world's most debilitating condition. Disk degeneration has been regarded as a strong determinant associated with LBP. Overweight and obesity are public health concerns that affect every population worldwide and whose prevalence continues to rise. Studies have indicated strong associations between overweight/obesity and disk degeneration as well as with LBP. This broad narrative review article addresses the various mechanisms that may be involved leading to disk degeneration and/or LBP in the setting of overweight/obesity. In particular, our goal is to raise awareness of the role of fat cells and their involvement via altered metabolism or the release of adipokines as well as other pathways that may lead to the development of disk degeneration and LBP. Understanding the role of fat in this process may aid in the development of novel biological therapies and technologies to halt the progression or regenerate the disk. Moreover, with genetic advancements and the appreciation of genetic epidemiology, a more personalized approach to spine care may have to consider the role of fat in any preventative, therapeutic, and/or prognosis modalities toward the disk and LBP.
Global Spine Journal 06/2013; 3(3):133-144. DOI:10.1055/s-0033-1350054
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