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SPORT study: Obese benefit less from surgical, conservative care for lumbar disc herniation
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Obese patients have poorer clinical outcomes after either surgical or conservative treatment for lumbar disc herniation compared to nonobese patients, according to recently published findings from the Spine Patient Outcomes Research Trial.
“The findings suggest that obese patients with symptomatic lumbar disc herniation do not do as well as nonobese patients with nonsurgical or surgical treatment,” Jeffrey Rihn, MD, study investigator and associate professor at Thomas Jefferson University Hospital and The Rothman Institute, stated in a press release.
Rihn and colleagues compared the outcomes of 854 nonobese patients with a body mass index (BMI) of ≤ 30 kg/m2 and 336 obese patients with a BMI ≥ 30 kg/m2. At 4-year follow-up, the investigators found that both operatively and nonoperatively treated obese patients had significantly less improvement from baseline Oswestry Disability Index scores than nonobese patients.
However, investigators found comparable changes in SF-36 bodily pain scores from baseline to 4-year follow-up in obese and nonobese patients who were conservatively treated. While surgically treated obese patients showed significantly less improvement using the Sciatica Bothersome Index and Low Back Pain Bothersome Index compared to nonobese surgically treated patients, according to the study abstract, investigators found no significant differences between the obese and nonobese patients regarding self-reported patient satisfaction scores.
Rihn and colleagues also noted that obese patients did not have increased risks of infection, reoperation, recurrent disc herniation or intraoperative complications.
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“The results of this study may be helpful in educating patients about their treatment options and expected outcomes,” Rihn stated in the press release. “These findings may suggest that weight loss should be encouraged in patients with this condition. However, this study does not specifically address whether weight loss in obese patients would affect their clinical outcome with nonsurgical or surgical treatment.”
Reference:
Rihn JA. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.K.01558.
Disclosure: Rihn receives royalties from DePuy, is on the editorial board for Spine and is a board member for the North American Spine Society.