Obese patients with symptomatic lumbar disc herniation are significantly more likely to opt for surgery than their healthy weight counterparts but derive less benefit, SPORT findings suggest.
"We believe that our results largely supported the hypothesis that obesity is associated with worse outcomes after operative or nonoperative treatment of lumbar disc herniation," say Jeffrey Rihn (Thomas Jefferson University Hospital, Philadelphia, Pennsylvania) and co-authors of SPORT (Spine Patient Outcomes Research Trial).
Nevertheless, the researchers found that surgery offered significantly better outcomes in all primary and secondary outcome measures compared with nonsurgical management for both obese and nonobese patients, except for return to work in obese patients.
"This result suggests that surgery offers a similar benefit over nonsurgical treatment regardless of the patient BMI," they write.
In the 4-year study, 55% of 336 patients with a body mass index (BMI) of 30 kg/m2 or above stated a preference for surgery and 73% underwent discectomy, compared with 48% and 63% of the 854 patients with a healthy BMI, respectively.
On average, obese patients had poorer baseline scores for the three primary measures of outcome - the Oswestry Disability Index (52.4 vs 48.4 points), and the Short Form (SF)-36 domains for bodily pain (25.0 vs 27.9 points) and physical function (32.5 vs 39.7 points).
Obese patients showed significantly less improvement after surgery than nonobese patients according to the Oswestry Disability Index (-33.7 vs -40.1), bodily pain (44.2 vs 50.0 points), and physical function (37.3 vs 47.7 points).
Obese patients also showed significantly less improvement than healthy weight patients at the 4-year follow-up on the Sciatica Bothersomeness Index or the Low Back Pain Bothersomeness Index. Although the two groups reported comparable satisfaction with their surgery and self-rated improvement, obese patients were less likely than nonobese patients to work full or part time at follow-up (77.5 vs 86.9%).
In addition, obese patients had a significantly longer operative time (86.5 vs 72.3 min), greater blood loss (83.2 vs 56.1 mL), and longer hospital stay (1.2 vs 0.9 days) than healthy weight patients.
However, obesity had no impact on the risk for nerve root injury, hematoma, infection, perioperative death, recurrence, or the need for further surgery.
The researchers report that for patients managed without surgery, obesity was also associated with less improvement on the Oswestry Disability Index and the SF-36 physical function domain but not the bodily pain scale. Secondary outcomes, including return to work, did not significantly differ for obese and nonobese patients.
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