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Obese lumbar discectomy patients have similar complication rates but worse outcomes than nonobese patients

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MANCHESTER — Obese patients had similar complication rates following lumbar discectomy as nonobese patients, however, they demonstrated less overall improvement, according to a recent study presented here.

At Ipswich Hospital in Suffolk, England, researchers recorded demographic information on 50 patients undergoing discectomy for a single-level, uncomplicated lumbar disc prolapse, including age, sex, weight and body mass index (BMI), which were recorded using the preoperative Oswestry Disability Index (ODI).

Fat thickness was measured at the L5/S1 spine level using calibrated MRI scans, research associate Helen Chase said at the British Orthopaedic Association Annual Congress 2009.

Outcome measures included complications, length of surgery and change in ODI at 1 year following surgery. Obesity was defined as a BMI of over 30: 16 patients had a BMI over 30 and were considered obese, while 34 had a BMI of less than 30.

The mean preoperative ODI was 46.5 in the obese group and 52 in the nonobese group, she said. The mean postoperative ODI statistically improved in the high BMI group to 28 — an 18.5-point improvement — and 25.2 for the nonobese group (a 26.8-point improvement).

Chase said the outcomes of lumbar discectomy in obese patients are ultimately mixed.

“We found no increase in the complication rate or intraoperative time associated with having an increased BMI,” she said. “However, the improvement in ODI was significantly better in the normal BMI group.”

She stressed the importance in conducting studies on the potential risks and outcomes of various spine surgeries in obese patients, especially when nearly 1 in 5 adults in the United Kingdom and 1 in 3 adults in the United States are considered obese.

“There are ramifications to these findings, and it helps surgeons and patients better understand what they can expect from surgery,” she said.

Audience members asked if she could speculate why obese patients’ ODI scores did not improve as significantly as those of nonobese patients.

“I don’t know why that is the case. That is something we will have to explore further,” she said.

Reference:

• Ollivere B, Chase H, Powell JM, et al. The outcome of lumbar discectomy in the obese. Presented at the British Orthopaedic Association Annual Congress 2009. Sept. 15-18, 2009. Manchester.