Obese (BMI >30) patients have greater functional improvement and reach equivalent outcomes at 12 months following decompression surgery for symptomatic lumbar stenosis

• Published in: World neurosurgery Vol. 105; pp. 884 - 894
• Main Authors: Elsayed, Galal, M.D, Davis, Matthew C., M.D, Dupépé, Esther C., M.D, McCluggage, Samuel G., M.D, Szerlip, Paul, PhD, Walters, Beverly C., M.D, M.Sc, Hadley, Mark N., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: Adult; Aged; Aged, 80 and over; Body Mass Index; Constriction, Pathologic - etiology; Decompression, Surgical - methods; Female; Humans; Lumbar stenosis; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; Male; Middle Aged; Neurosurgery; Obesity; Obesity - physiopathology; Outcome assessment; Retrospective Studies; Spinal Fusion - methods; Spinal Stenosis - surgery; Surveys and Questionnaires; Treatment Outcome; Body Mass Index; EQ-5D; American Society of Anesthesiologist Score; STROBE; Institutional Review Board; ASA; lumbar stenosis; EuroQol 5 dimensions quality of life survey; Oswetry Disability Index; ODI; UAB; IRB; outcome assessment; neurosurgery; adult; obesity; University of Alabama-Birmingham; BMI; StrengThening the Reporting of Observational Studies in Epidemiology; Obesity; Lumbar stenosis; SPORT; CI; Adult; Neurosurgery; Outcome assessment
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.072

Abstract Objective Here we evaluate the effect of obesity on 12-month functional outcomes following surgery for lumbar stenosis in an adult population. Methods Data were collected prospectively on patients treated with lumbar laminectomy for symptomatic lumbar spinal stenosis as part of an observational registry at a single institution from 2012 through 2014, and analyzed using a retrospective cohort study design. Patients with BMI>30 were compared to patients with BMI <30 with respect to baseline, 3-month, and 12-month functional status, adjusted for potential confounders. Results 101 patients were included. At baseline, patients with BMI >30 had significantly more back pain on a 0-10 visual analogue scale (mean difference 1.3, p<0.001), more leg pain (mean difference 1.11, p<0.001), lower EQ-5D scores (mean difference 0.14, p<0.001), and higher ODI scores (mean difference 8.54, p<0.001). In paired testing, both low- and high-BMI groups had significant improvement in back pain, leg pain, higher EQ-5D scores, and lower ODI scores following decompression surgery for lumbar spinal stenosis (all p values <0.001). The difference between low- and high-BMI groups trended toward significance at 3 months postoperatively, with high-BMI patients continuing to report greater leg pain (mean difference 1.34, p=0.063) and higher ODI score (mean difference 8.7, p=0.064) relative to low-BMI patients. By 12 months, there was no difference between patients with BMI >30 and patients with BMI<30 in back pain (p=0.929), leg pain (p=0.638), EQ-5D score (p=0.733) or ODI score (p=0.214). Conclusion Both low- and high-BMI group patients treated with decompression for lumbar spinal stenosis had significant improvement in back pain, leg pain, ODI score, and EQ-5D score at 3 months postoperatively. The difference between low- and high-BMI patients trended toward statistical significance for leg pain and ODI score at 3 months, but this difference disappeared by 12 months. This suggests that obese patients with symptomatic lumbar spinal stenosis may require longer to recover after decompression surgery, but can expect to reach equivalent outcomes of similarly treated patients with BMI<30.