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Does Obesity Affect the Results of Back Surgery?

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Updated June 02, 2010

Question: Does Obesity Affect the Results of Back Surgery?
Answer:

Complications from back surgery do occur more frequently in obese patients. And, unfortunately, obese people are more likely to require back surgery than those of a healthy weight.

Researchers from Thomas Jefferson University found that the risk for surgery complications increases relative to the degree of obesity. In other words, the higher your body mass index (BMI), the greater is the chance that you will experience a problem related to your back surgery.

One study found the complication rate for surgical patients of a healthy weight to be 14%. But for those with a BMI greater than 40 (normal range is 18.5 to 25; 40 or more indicates morbid obesity), it jumped to 36%. In particular, complications with spinal fusion for patients with high BMIs are a concern to doctors. The possibility of a failed surgery is also there. The American Academy of Neurosurgeons states that, in surgeries done to relieve low back pain, the failure rate for patients whose BMI is over 40 is increased.

Both the type of surgery and the reason for having it affect outcomes. Most of the time, wound healing is the top related complication for obese patients. The American Academy of Neurosurgeons also notes that pneumonia, deep vein thrombosis and the need for further surgery are common. Other adverse outcomes can include diabetes, kidney failure, hypertension, heart disease, liver disease, and nerve compressions.

As in any type of surgery, there are a number of possible problems related to anesthesia to also consider. Anesthesia makes you more vulnerable to sleep apnea, and this may be worsened by decreased ability of the chest wall and lungs to function under the extra weight.

Hypoxia-hypoventilation, a condition that can hinder your ability to breathe, is present in 10% of morbidly obese people, and may result in unnecessary oxygen treatment during the surgery.

Anesthesia and pain medication that works on the central nervous system can depress the muscles that open up the pharynx, which allows air to pass through during breathing. This is a very serious condition that may add to the breathing problems associated with obesity. Unfortunately, it may even be fatal.

Positioning an obese patient for surgery can be very dangerous. It is often a choice between making one of your other medical problems worse and being able to reach the surgery site. During the surgery, it may be difficult for the doctor or nurse to monitor your blood pressure. After surgery, airway obstruction may present very serious challenges, as well.

Losing weight before you go in for your surgery can help decrease problems with apnea, positioning and blood pressure monitoring.

In general, however, experts recommend that obese patients not be denied back surgery because of their condition. Minimally invasive spine surgery (MIS) poses fewer complication risks than the traditional type.

Although not all the questions have been answered, preliminary data on the use of MIS techniques for obese spine patients is promising in terms of both safety and results. For example, one study of 108 participants showed that obese patients receiving MIS lumbar interbody fusion had the same results as patients with healthy weights. Another study that looked at 77 MIS patients, showed equivocal results between those who were obese and those at a healthy weight for several types of spine procedures: disectomy, laminectomy and spinal fusion.

Pain following an MIS procedure is greatly minimized, which allows patients to resume their activities more quickly. This may explain why studies show spinal fusions performed with MIS techniques have begun to answer questions about complications associated with traditional fusions.

The American Academy of Neurosurgeons suggests the equalizing effect that minimally invasive spine surgery has on obese patients has to do with the greatly reduced degree of disruption the procedures have on the soft tissues, and the small, "precisely guided" travel route of the instruments once they are inside the body. MIS uses fluoroscopy to permit very small incisions and to navigate the surgical instrument to its destination. Advances in technology have resulted in finely tuned instruments, and have all but eliminated imaging problems related to the presence of fat tissue.

As with any consideration of back surgery, conservative and non-invasive care should always be tried first. This will probably mean going for physical therapy sessions that emphasize back exercises and core strengthening programs. Although being overweight or obese makes sticking with an exercise program more difficult, it is in your best interest to put forth the effort. Exercise may be the key to avoiding the surgery. In fact, American Family Physician reports that adhering to an aggressive exercise program as administered by a physical therapist has shown to reduce the need for back surgery. If doing the exercises proves just too difficult, ask your therapist about an aquatics program, which is easier on the joints.

Source:

Thomas Jefferson University. "Obesity Tied To Higher Risk Of Complications In Spinal Surgery." ScienceDaily 12 October 2006. 27 October 2008 http://www.sciencedaily.com/releases/2006/10/061010022634.htm

Park P, Upadhyaya C, Garton HJ, Foley KT. The impact of minimally invasive spine surgery on perioperative complication in overweight or obese patients. Neurosurgery. Mar. 2008.

Postoperative complications in obese and nonobese patients," World Journal of Surgery; March 2007, Vol. 31, 556--560

Benzil, D. MD. Obesity: What Are the Complications For Your Patients? AANS Bulletin 2008 Volume 17 Issue 2.

Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine. May 1989.

Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, Harrop J, Sharan A, Ratliff JK. Obesity and spine surgery: relation to perioperative complications. J Neurosurgery Spine Apr 2007.

McCormick, P. Lumbar Spine Disease: Considerations for Obese Patients AANS Bulletin 2008 Volume 17 Issue 2.

McGoldrick, K, MD, Benzil, D, MD. Obesity and Anesthetic Care: Implications for Neurosurgical Patients. AANS Bulletin 2008 Volume 17 Issue 2.

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