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Weight Loss in Overweight and Obese Patients Following Successful Lumbar Decompression

Garcia, Ryan M. MD; Messerschmitt, Patrick J. MD; Furey, Christopher G. MD; Bohlman, Henry H. MD; Cassinelli, Ezequiel H. MD

Journal of Bone & Joint Surgery - American Volume: 01 April 2008 - Volume 90 - Issue 4 - p 742–747
doi: 10.2106/JBJS.G.00724
Scientific Articles

Background: Neurogenic claudication secondary to lumbar stenosis is often cited by overweight and obese patients as a factor limiting their ability to lose weight. Many patients believe that they will be able to increase their activity and subsequently lose weight following relief of symptoms. The objective of this study was to evaluate weight loss in overweight and obese patients who obtained substantial pain relief after lumbar decompression surgery for spinal stenosis.

Methods: Changes in the body weight and body mass index of overweight and obese patients after lumbar decompression surgery were assessed at a mean of 34.4 months postoperatively. Sixty-three patients (thirty-seven men and twenty-six women with a mean age of 53.4 years) were included in the study. Preoperative and postoperative body weight and body mass indices were calculated, and Zurich Claudication Questionnaire (ZCQ) Symptom Severity and Physical Function scores were obtained.

Results: The ZCQ Symptom Severity and Physical Function scores significantly improved, by a mean of 56.4% and 53.0%, respectively. At the time of follow-up, both the mean body weight and the mean body mass index significantly increased, by 2.48 kg and 0.83 kg/m2, respectively. Overall, 35% of the patients gained ≥5% of their preoperative body weight, 6% of the patients lost ≥5% of their preoperative body weight, and 59% remained within 5% of their preoperative body weight.

Conclusions: The majority of overweight and obese patients maintain or increase their body weight and body mass index following successful lumbar decompression surgery. Substantial relief of symptoms and functional improvements do not appear to help overweight or obese patients to lose weight. This suggests that obesity is an independent disease and not simply a function of symptomatic spinal stenosis, and patients should be counseled regarding these expectations.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106

2Peachtree Orthopaedic Clinic, 5505 Peachtree Dunwoody Road, Suite 600, Atlanta, GA 30342. E-mail address: zcassinelli@pocatlanta.com

Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated
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