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Does obesity impact lumbar sagittal alignment and clinical outcomes after a posterior lumbar spine fusion?

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Abstract

Purpose

The purpose of this study is to compare clinical patient-reported outcomes and radiographic sagittal parameters between obese and non-obese patients following open posterior lumbar spine fusion (PLSF).

Methods

A retrospective cohort study was conducted for patients who underwent open PLSF from 2011 to 2018. Patients were classified as obese as per Center for Disease Control and Prevention guidelines if their body mass index (BMI) ≥ 30 kg/m2. Preoperative and final visual analog scale (VAS) back pain, VAS leg pain, and Oswestry Disability Index (ODI) were obtained for both obese and non-obese groups. Achievement of minimal clinically important difference was evaluated. Preoperative, immediate postoperative, and final lumbar plain radiographs were assessed to measure spinopelvic parameters. Additionally, postoperative complication measures were collected.

Results

A total of 569 patients were included; 290 (50.97%) patients with BMI < 30 (non-obese) and 279 (49.03%) patients with BMI ≥ 30 (obese). Patients classified as obese were more likely to have a diagnosis of diabetes mellitus (p < 0.001), and American Society of Anesthesiologists Physical Status Classification System of ≥ 3 (p < 0.001). Obese patients had significantly longer operative times (p < 0.001) compared to non-obese patients. There was no difference in radiographic measurements, patient-reported outcomes, postoperative complications, or reoperations between groups.

Conclusion

Obese patients had significantly more comorbidities and longer operative time compared to non-obese patients. However, sagittal parameters, patient-reported outcomes, inpatient complications, length of hospital stay, and reoperations were similar between groups. Given these findings, open PLSF can be considered safe and effective in obese patients after thorough consideration of related comorbidities.

Graphic abstract

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Funding

No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL, 60612, USA

    Jannat M. Khan, Bryce A. Basques, Kyle N. Kunze, Gagan Grewal, Young Soo Hong, Coralie Pardo, Philip K. Louie, Matthew Colman & Howard S. An

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  1. Jannat M. Khan
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  2. Bryce A. Basques
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  3. Kyle N. Kunze
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  4. Gagan Grewal
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Corresponding author

Correspondence to Bryce A. Basques.

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Conflict of interest

Jannat M. Khan, Bryce A. Basques, Kyle K. Kunze, Gagan Grewal, Young Soo Hong, Coralie Pardo, Philip K. Louie, and Matthew Colman declare that they have no conflict of interest. Howard S. An reports other from U&I Inc., Zimmer, Articular Engineering LLC, Medyssey Inc., Spinal Kinetics, Bioventis, Stryker, American Journal of Orthopaedics, Spine Journal, with grants from Medyssey Inc., and Spinalcyte Inc., outside the submitted work.

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Khan, J.M., Basques, B.A., Kunze, K.N. et al. Does obesity impact lumbar sagittal alignment and clinical outcomes after a posterior lumbar spine fusion?. Eur Spine J 29, 340–348 (2020). https://doi.org/10.1007/s00586-019-06094-y

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  • DOI: https://doi.org/10.1007/s00586-019-06094-y

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