(Press-News.org) Rosemont, Ill. – While obese patients are more likely to have surgical treatment for lumbar disc herniation – a slipped or ruptured disc – than nonobese patients, obesity increases operative time, blood loss and length of hospital stay, according to new research published in the January 2013 Journal of Bone and Joint Surgery (JBJS). Overall, obese patients had poorer outcomes with surgical and nonsurgical treatments for lumbar disc herniation than nonobese patients.
The study included 854 nonobese patients with a Body Mass Index (BMI) of less than 30 kg/m², and 336 obese patients with a BMI greater than 30 kg/m², enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of lumbar disc herniation. Researchers compiled patient demographic and clinical characteristics at baseline, and then compared that information with data compiled during regular follow-up visits for four years.
At four years, improvements in function were less for obese patients – in both the surgical and nonsurgical groups – as measured by the Oswestry Disability Index. Reported pain (using the Short Form-36 scale) was statistically similar for obese and non-obese patients.
"The findings suggest that obese patients with symptomatic lumbar disc herniation do not do as well as nonobese patients with nonsurgical or surgical treatment," said Jeffrey Rihn, MD, associate professor at Thomas Jefferson University Hospital and The Rothman Institute.
Other Key Findings:
Obese patients did not have an increased rate of infection, intraoperative complications, recurrent disc herniation or reoperation.
Obese patients had significantly less improvement in the Sciatica Bothersomeness Index and Low Back Pain Bothersomeness Index, but reported no significant difference in self-rated overall improvement/satisfaction.
The benefit of surgery over nonoperative treatment was not affected by body mass index.
Recurrence of disc herniation and need for additional surgical procedures did not differ significantly between obese and nonobese patients. This finding contradicts previous studies on this topic.
"The results of this study may be helpful in educating patients about their treatment options and expected outcomes," said Dr. Rihn. "These findings may suggest that weight loss should be encouraged in patients with this condition. However, this study does not specifically address whether weight loss in obese patients would affect their clinical outcome with nonsurgical or surgical treatment."
INFORMATION:
About JBJS
January 2nd Full JBJS Table of Contents
Herniation-Analysis of the Spine Patient Outcomes Research Trial (SPORT)
Surgically Treated Humeral Shaft Fractures Following Shoulder Arthroplasty
Effect of Sliding-Taper versus Composite-Beam Cemented Femoral Prosthesis Loading Regime on Bone Remodeling of the Proximal Femur: A Randomized Clinical Trial
Natural History of Unreduced Gartland Type-II Supracondylar Fractures of the Humerus in Children: A 2-to-13 Year Follow up
Transphyseal Anterior Cruciate Ligament Reconstruction in the Skeletally Immature: A Follow-up to Minimum of 16 Years of Age
Immature: A Follow-up to Minimum of 16 Years of Age
Intraosseous Injection of rhBMP-2/Calcium Phosphate Matrix Improves Bone Structure and Strength of the Proximal Femur in Chronic Ovariectomized Nonhuman Primates
The Effect of Bone Lavage on Femoral Cement Penetration and Interface Temperature during Cemented Oxford Unicompartmental Knee Arthroplasty
Flexor Hallucis Longus Tendon Transfer in Treatment of Achilles Tendinosis
Risk Factors of Nonunion in Patients with Intracapsular Femoral Neck Fractures Treated with 3 Cannulated Screws Placed in Either a Triangle or Inverted Triangle Configuration
The High Variability in Sizing Knee Cartilage Defects
A Nation in Motion
More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide the best value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this "Nation in Motion." To learn more, to read hundreds of patient stories or to submit your own story, visit anationinmotion.org.
More information on knee replacement can be found at orthoinfo.org
END
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