Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery

  • Alexandre Peixoto de MelloEmail author
  • Glaucus Cajaty dos Santos Martins
  • André Raposo Heringer
  • Raphael Barbosa Gamallo
  • Luiz Felippe dos Santos Martins Filho
  • Antônio Vítor de Abreu
  • Antonio Carlos Pires Carvalho
  • Maurício de Pinho Gama
Original Article



The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients.


The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software.


The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups.


Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Obesity Neck pain Low back pain Sagittal alignment parameters Spinopelvic parameters 



We thank Peter Mittwede, MD, PhD, from Edanz Group ( for editing a draft of this manuscript. We thank Isabela Peixoto de Mello for drawing the figure representing the measures.

Author contributions

Alexandre Peixoto de Mello and Glaucus Cajaty dos Santos Martins designed the studies, analyzed data and wrote the manuscript. André Raposo Heringer and Raphael Barbosa Gamallo collected the data from the patients. Maurício de Pinho Gama revised the statistics. Luiz Felippe dos Santos Martins Filho, Antônio Vítor de Abreu and Antonio Carlos Pires Carvalho revised the analyzed data and the manuscript.


The study was performed using personal resources from the authors and exams performed at Hospital Federal de Ipanema as part of the pre-operative evaluation.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Supplementary material

586_2019_5935_MOESM1_ESM.pptx (136 kb)
Supplementary material 1 (PPTX 136 kb)
586_2019_5935_MOESM2_ESM.xlsx (14 kb)
Supplementary material 2 (XLSX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alexandre Peixoto de Mello
    • 1
    • 2
    Email author
  • Glaucus Cajaty dos Santos Martins
    • 3
    • 4
  • André Raposo Heringer
    • 4
  • Raphael Barbosa Gamallo
    • 4
  • Luiz Felippe dos Santos Martins Filho
    • 4
  • Antônio Vítor de Abreu
    • 3
  • Antonio Carlos Pires Carvalho
    • 3
  • Maurício de Pinho Gama
    • 3
    • 5
  1. 1.Universidade Federal do Estado do Rio de Janeiro (UNIRIO)Rio de JaneiroBrazil
  2. 2.Instituto Nacional de Traumatologia e Ortopedia (INTO)Rio de JaneiroBrazil
  3. 3.Universidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  4. 4.Hospital Federal de Ipanema (HFI)Rio de JaneiroBrazil
  5. 5.Universidade de Brasília (UnB)BrasiliaBrazil

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