Obesity is an increasing concern for both healthcare professionals and national governments given the impact that it has on health and, as a result of obesity-related conditions, healthcare costs. Michael Zindrick, Hinsdale Orthopaedics, Hinsdale, USA, talked to Spinal News International about the effect of obesity on the spine and how obese patients who have spinal conditions should be managed.
Does obesity increase the risk of spinal conditions?
There are several studies that point to an increased incidence of low-back pain and degenerative disc disease in obese and morbidly obese patients compared with their non-obese counterparts1–6. Obesity is often associated with numerous comorbidities (eg, hypertension) that can affect the macro- and microcirculation of the disc. These factors, combined with mechanical overload due to excessive weight, can lead to early disc degeneration.
Does it increase the risk of complications?
Yes, surgical complications are increased in the obese patient population because of the serious comorbidities associated with obesity and the issues of increased patient size complicating preoperative and intraoperative imaging, intraoperative positioning, and surgical exposure. Specifically, the most common complications associated with obesity are lengthened surgical times, intraoperative bleeding, anaesthetic complications, postoperative infections and medical complications as a result of obesity-related comorbidities.
How can the risk of complications be reduced?
If possible, for elective surgery, preoperative weight loss should be attempted with medical supervision. Surgical weight loss procedures should be considered.
A thorough preoperative evaluation can identify—and correct or optimise—any medical issues before surgery. Also, thorough preoperative preparation is needed to confirm that the appropriate equipment required for operating on a larger patient is available, which includes longer surgical instruments, an appropriate operative table, and a fluoroscopic unit that will accommodate a patient’s increased size.
Post surgery, vigilant medical and surgical management are necessary to prevent complications and identify and address early on any issues that should arise.
Is obesity a contraindication to spinal surgery?
No, spinal surgery should not be denied to the obese patient who has surgically correctable pathology and has failed conservative treatment. Thorough preoperative evaluation, a prepared surgical team, armed with the appropriate tools, and close postoperative monitoring can help to ensure that obese patients have similar surgical outcomes to non-obese spinal surgery patients.
1. Lidar et al. Spine 2012
2. Samartzis et al.J Bone Joint Surg Am 2011 6; 93:662–70
3. Weiler, et al. BMC Res Notes 2011; 4:497
4. Shiri, et al. Am J Epidemiol 2010; 171:135–54
5. Liuke, et al. Int J Obes (Lond) 2005; 29:903–8
6. Leboeuf-Yde. Spine 2000; 25:226–37