Obesity and Spine Surgery
Hi, this is Dr. John Shim, and this is another "can you handle the truth moment?" Yes, your weight can have an effect on your back pain. I'm not judging any of you. Frankly, I've had my own challenges in staying within the weight guidelines, but the truth is fairly simple to demonstrate. Have you ever carried around a 20-pound bag? Have you ever tried to carry it all day? If you're honest with yourself, you know that it becomes a burden over time. It makes you tired, and after a certain amount of time, most of us will just stop carrying it. Well, if you're 20 pounds overweight - it really is the same thing. Now, imagine if you also had back pain. How difficult would it be to carry that 20-pound bag all day? Kind of common sense, isn't it? So what do the scientists say about weight and back pain? Surprisingly, the answer is a bit mixed. Many studies have shown a weak correlation of obesity and back pain. On the other hand, many studies have also shown significant decrease in outcome for obese patients when they have spinal fusion surgeries. The reasons may be a chicken or egg situation. Obesity has relationships to heredity, culture, and our modern society. Obesity may be secondary to our sedentary lifestyle, and diet habits. These same habits lead to inactivity, deconditioning, and inflammation of body chemistry's. These same factors can contribute to the development of back pain. Regardless of the week scientific correlation of obesity and back pain - to me the common sense holds true. We definitely know that obesity contributes to increased healthcare costs for society, and leads to other medical conditions that can also contribute to back pain. As a physician, I can tell you that in my experience fit, normal weight people rarely come to my office for long-term treatment of back pain. To me it is obvious. Your weight has a significant effect on your back pain and recovery from back pain. Remember, I'm not judging. I'm just telling you my experience. If you have issues with weight please talk to your physicians about a weight loss program. I'm Dr. John Shim, and I'm glad we had a chance to talk about this difficult subject. Thanks for listening.
Obesity and Spine Surgery is a sensitive issue. The March 1 issue of Spine does tackle this issue by comparing the results of surgery for obese patients to normal weight patients. Not surprisingly, the results do show a difference, with patients in the obese catagory having inferior rates of success compared to the normal weight patients.
The good new, however, is that Obesity and Spine Surgery can still yield improvements to the patients. But, a higher BMI (body mass index= Weight in kilograms/ height in meters squared) was associated with greater odds of dissatisfaction after surgery, and according to the study, inferior results at the 2 year followup.
Overall satisfaction of surgery at 2 years, was 67% for normal weight patients (BMI<25). 64% in over weight patients (BMI 25-30), and 57% of patients who are considered obese (BMI>30). Statistically, there was a definite difference in the outcome comparing the normal weight to the obese patients.
Surgical intervention was for patients with Lumbar Spinal Stenosis. Data was from the Swedish Spine Registry, with more than 80% of the total surgical procedures for degenerative lumbar disorders included. The population includes 2633 patients. The study was not clear about the exact nature of the surgery, but surgical interventions most likely are laminectomies, with some fusions.
The whole concept of Obesity and Spine Surgery is controversial. While we think it is common sense that Obesity would be associated with increasing low back pain, the data has been conflicting. Not every study has demonstrated this correlation.
The authors of the study does discuss some of the short comings of the study. But, concludes obesity is a factor when trying to stratify a patient population that might benefit from Lumbar Spinal Surgery. The study actually does not demonstrate a great overall success rate for any of the lumbar surgeries, as even in the normal weight group, satisfaction was only 67%.
Still, the study did confirm a common consensus opinion, which is Obesity and Spine Surgery, while at times necessary, can result in inferior success rates for patient satisfaction.
- Hart RA. The Spine Patient Outcomes Research Trial (SPORT): a continuing return on investment: commentary on an article by Jeffrey A. Rihn, MD, et al.: "The influence of obesity on the outcome of treatment of lumbar disc herniation. analysis of the Spine Patient Outcomes Research Trial (SPORT)". J Bone Joint Surg Am. 2013 Jan 2;95(1):e5. PubMed PMID: 23192422