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The Effect of Obesity on Clinical Outcomes After Lumbar Fusion

Djurasovic, Mladen MD*†; Bratcher, Kelly R. RN*; Glassman, Steven D. MD*†; Dimar, John R. MD*†; Carreon, Leah Y. MD, MSc*

doi: 10.1097/BRS.0b013e31817b8f6f
Health Services Research

Study Design. Retrospective cohort analysis.

Objective. To investigate and compare back and leg pain, and health-related quality of life measures in obese patients undergoing lumbar spine fusion, and to compare the results to nonobese patients.

Summary of Background Data. Obesity is a growing healthcare crisis in the United States and an increasing number of patients undergoing spinal surgery are obese. Obesity is also associated with low back pain. Some obese patients with significant structural spine problems may be dismissed as having their pain only coming from their weight. We compared patient outcomes in obese and nonobese patients undergoing lumbar fusion surgery.

Methods. We retrospectively reviewed a single-center patient database of patients undergoing lumbar fusion and identified 270 patients with greater than 2-year outcome data. Body mass index (BMI) was calculated and patients were classified as obese (BMI ≥ 30) or nonobese (BMI < 30). All patients completed Oswestry Disability Index (ODI), Short Form (SF)-36 questionnaires, and back and leg pain numerical rating scores before surgery and at 2 years. We compared clinical outcomes and complication rates in the 2 groups.

Results. The overall study group consisted of 109 obese patients and 161 nonobese patients. Both the obese and nonobese patients demonstrated significant improvements in back pain, leg pain, SF-36 physical composite summary (PCS), and ODI scores (P < 0.001) at 2-year follow-up compared with baseline. There was no significant difference in the mean improvements seen in obese patients compared with nonobese patients with respect to back pain, leg pain, or SF-36 PCS or ODI scores. Both SF-36 PCS (P = 0.037) and ODI score (P = 0.028) at 2-year follow-up were better in the nonobese patients compared with the obese patients. Overall complication rates were slightly higher in the obese group (P = 0.045), predominantly because of wound-related complications.

Conclusion. Obese patients undergoing lumbar fusion achieve similar benefits to nonobese patients. Wound-related complications are more common in obese patients. Obese patients with otherwise good indications for lumbar fusion should not be denied this procedure because of their weight.

We examined the effect of obesity on outcomes after lumbar fusion surgery. Both obese and nonobese patients showed similar improvements after lumbar fusion. Obese patients with evident indications for lumbar fusion can expect similar degrees of improvement to nonobese patients.

From the *Kenton D. Leatherman Spine Center, and the †Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY.

Acknowledgment date: November 13, 2007. Acceptance date: February 18, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

Address correspondence and reprint requests to Leah Y. Carreon, MD, MSc, Kenton D. Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.