General Session: Value and Outcomes in Spine Surgery

Presented by: J. Joseph - View Audio/Video Presentation (Members Only)

Author(s):

J. Joseph(1), Z. Farooqui(1), B. Smith(1), E. Kahn(1), F. La Marca(1), P. Park(1)

(1) University of Michigan, Ann Arbor, MI, United States

Abstract

Background: Obesity and low back pain associated with degenerative spondylosis or spondylolisthesis are common comorbid conditions. Many patients report that the pain and disability associated with degenerative lumbar disease are key factors in their inability to lose weight. The aim of this retrospective study was to determine if there is an association between improved functional status and weight loss following a successful TLIF procedure.

Methods: A retrospective cohort study of patients who underwent single-level TLIF was performed. Inclusion criteria were a preoperative body mass index (BMI) greater than 30, achievement of minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (defined as improvement of 15), and minimum 1-year postoperative follow-up BMI. Preoperative and postoperative BMI, ODI, and Visual Analog Scale (VAS) were compared. A subgroup analysis of patients that achieved substantial clinical benefit (SCB, defined as an improvement of 19 in ODI) was also performed.

Results: 56 patients met the inclusion criteria. Mean age was 55.6 ± 13.7 years. Mean preoperative BMI was 34.8 ± 4.6. Mean preoperative ODI was 66.2 ± 10.1 and mean preoperative VAS was 7.1 ± 1.7. Mean change in ODI was -33.1 ± 13.5 (p< 0.01) and mean change in VAS was -4.1 ± 2.1 (p< 0.01). Mean change in BMI was +0.15 ± 2.1 (range -4.2 to +6.5, p=0.6). 46 patients achieved SCB on ODI. Mean preoperative BMI for SCB patients was 34.8 ± 4.8, and mean postoperative BMI was 34.7 ± 5.0. Mean change in BMI was -0.03 ± 1.9 (p=0.9).

Conclusion: Despite successful surgical intervention with achievement of improved function and pain, obese patients did not have significant change in weight post-operatively.