Does Obesity Affect Outcomes After Decompressive Surgery for Lumbar Spinal Stenosis? A Multicenter, Observational, Registry-Based Study

Charalampis Giannadakis; Ulf S Nerland; Ole Solheim; Asgeir S Jakola; Michel Gulati; Clemens Weber; Øystein P Nygaard; Tore K Solberg; Sasha Gulati

doi:10.1016/j.wneu.2015.06.020

Does Obesity Affect Outcomes After Decompressive Surgery for Lumbar Spinal Stenosis? A Multicenter, Observational, Registry-Based Study

World Neurosurg. 2015 Nov;84(5):1227-34. doi: 10.1016/j.wneu.2015.06.020. Epub 2015 Jun 20.

Authors

Charalampis Giannadakis¹, Ulf S Nerland², Ole Solheim³, Asgeir S Jakola⁴, Michel Gulati⁵, Clemens Weber⁶, Øystein P Nygaard⁷, Tore K Solberg⁸, Sasha Gulati⁹

Affiliations

¹ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: charalampis.giannadakis@ntnu.no.
² Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
³ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit in Ultrasound and Image-Guided Surgery, Trondheim, Norway.
⁴ National Advisory Unit in Ultrasound and Image-Guided Surgery, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Surgery, Ålesund Hospital, Ålesund, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
⁶ National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olavs University Hospital, Trondheim, Norway; Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway.
⁷ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olavs University Hospital, Trondheim, Norway.
⁸ Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; The Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway.
⁹ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olavs University Hospital, Trondheim, Norway; Norwegian Centre of Competence in Deep Brain Stimulation for Movement Disorders, St. Olavs University Hospital, Trondheim, Norway.

PMID: 26100169
DOI: 10.1016/j.wneu.2015.06.020

Abstract

Objective: To evaluate the association between obesity and outcomes 1 year after laminectomy or microdecompression for lumbar spinal stenosis (LSS).

Methods: The primary outcome measure was the Oswestry Disability Index (ODI). Obesity was defined as body mass index (BMI) ≥ 30. Prospective data were retrieved from the Norwegian Registry for Spine Surgery.

Results: For all patients (n = 1473) the mean improvement in ODI at 1 year was 16.7 points (95% CI 15.7-17.7, P < 0.001). The improvement in ODI was 17.5 points in nonobese and 14.3 points in obese patients (P = 0 .007). Obese patients were less likely to achieve a minimal clinically important difference in ODI (defined as ≥ 8 points improvement) than nonobese patients (62.2 vs. 70.3%, P = 0.013). Obesity was identified as a negative predictor for ODI improvement in a multiple regression analysis (P < 0.001). Nonobese patients experienced more improvement in both back pain (0.7 points, P = 0.002) and leg pain (0.8 points, P = 0.001) measured by numeric rating scales. Duration of surgery was shorter for nonobese patients for both single- (79 vs. 89 minutes, P = 0.001) and 2-level (102 vs. 114 minutes, P = 0.004) surgery. There was no difference in complication rates (10.4% vs. 10.8%, P = 0.84). There was no difference in length of hospital stays for single- (2.7 vs. 3.0 days, P = 0.229) or 2-level (3.5 vs. 3.6 days, P = 0.704) surgery.

Conclusions: Both nonobese and obese patients report considerable clinical improvement 1 year after surgery for LSS, but improvement was less in obese patients. Obese patients were less likely to achieve a minimal clinically important difference.

Keywords: Neurosurgical procedures; Obesity; Quality of life; Spinal stenosis; Spondylosis.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Decompression, Surgical*
Disability Evaluation
Female
Humans
Laminectomy
Longevity
Low Back Pain / therapy
Lumbar Vertebrae / surgery*
Male
Middle Aged
Neurosurgical Procedures*
Obesity / complications*
Postoperative Complications / epidemiology
Prognosis
Prospective Studies
Registries
Spinal Stenosis / complications*
Spinal Stenosis / surgery*
Treatment Outcome