The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation Analysis of the Spine Patient Outcomes Research Trial (SPORT)

Dartmouth–Hitchcock Medical Center, LEB, New Hampshire, United States
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 11/2012; 95A(1). DOI: 10.2106/JBJS.K.01558
Source: PubMed


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.

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    • "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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    ABSTRACT: Objective The purpose of this study was to evaluate the effect of patients' bod mass index (BMI) on surgical outcomes following one-level lumbar microdiscectomy. Methods 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. Results 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. Conclusion 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.
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    ABSTRACT: Purpose: Numerous studies have investigated the significant relationship between sciatic pain, radiating lower back pain, lumbosacral radicular syndrome or other disk disorders and cigarette smoking; however, only few reports have demonstrated the relationship between the total smoking dose and lumbar disk herniation (LDH), a cause of lower back or sciatic pain. Furthermore, the relationship between total cigarette consumption and the need of surgical intervention for LDH has not yet been investigated. Materials and Methods: This study included 391 patients with symptomatic LDH. The control group comprised 431 inpatients admitted for other medical or surgical problems. Their demographic data and level of cigarette consumption were obtained through a chart review. The association between lumbar surgical intervention and the clinical characteristics were investigated by multiple logistic regression analyses, with stepwise selection. Results: Compared with the nonsmokers, the smokers had a 1.5-fold increased risk of developing LDH (P = 0.01). An increased total smoking dose (pack-years) was a risk factor of undergoing lumbar surgical intervention among the LDH patients (odds ratio [OR] = 1.02; P = 0.03). Furthermore, the risk of undergoing lumbar surgical intervention increased to 1.83 times among LDH patients with a 6-10-year smoking history and to 2.16 times among those with >10-year smoking history (P = 0.02 and P = 0.002, respectively). Conclusion: This study found that the total cigarette smoking dose was associated with LDH and was a risk factor for undergoing surgical intervention for LDH.
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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.
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