Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

Soroceanu, Alex; Burton, Douglas C.; Diebo, Bassel G.; Smith, Justin S.; Hostin, Richard A.; Shaffrey, Christopher I.; Boachie-Adjei, Oheneba; Mundis, Gregory M.; Ames, Christopher P.; Errico, Thomas J.; Bess, Shay; Gupta, Munish C.; Hart, Robert A.; Schwab, Frank J.; Lafage, Virginie; ., .

doi:10.3171/2015.3.spine14743

Cited by 96 publications

(55 citation statements)

References 81 publications

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“…15 Another study, by Ayhan et al, also revealed that in 121 patients who underwent adult deformity correction, a total of 114 complications (59 major, 55 minor) and 1 death were noted. 5 At Level II evidence there is significant quality of life improvement, 20 and with complications, the final outcome of radiological correction did not change. 19 So unless there are strong indications to undertake deformity correction surgery, smaller procedures aiming to provide symptomatic relief from radicular pain may be worth considering.…”

Section: Discussionmentioning

confidence: 87%

“…6 Every "redo" spine surgery in itself is quite complicated, and more so when it is performed in the elderly population. 20 Addressing the entire spine as a single unit enables the surgeon to plan the possible future procedures with minimal complications. 13,25 Endoscopic discectomy enables the preservation of all the essential structures with minimal complications, although there is a steep learning curve for beginners.…”

Section: Discussionmentioning

confidence: 99%

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Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity

Madhavan

Chieng

McGrath

et al. 2016

FOC

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OBJECTIVE Asymmetrical degeneration of the disc is one of the most common causes of primary degenerative scoliosis in adults. Coronal deformity is usually less symptomatic than a sagittal deformity because there is less expenditure of energy and hence less effort to maintain upright posture. However, nerve root compression at the fractional curve or at the concave side of the main curve can give rise to debilitating radiculopathy. METHODS This study was a retrospective analysis of 16 patients with coronal deformity of between 10° and 20°. All patients underwent endoscopic foraminal decompression surgery. The pre- and postoperative Cobb angle, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index scores were measured. RESULTS The average age of the patients was 70.0 ± 15.5 years (mean ± SD, range 61–86 years), with a mean followup of 7.5 ± 5.3 months (range 2–14 months). The average coronal deformity was 16.8° ± 4.7° (range 10°–41°). In 8 patients the symptomatic foraminal stenosis was at the level of the fractional curve, and in the remaining patients it was at the concave side of the main curve. One of the patients included in the current cohort had to undergo a repeat operation within 1 week for another disc herniation at the adjacent level. One patient had CSF leakage, which was repaired intraoperatively, and no further complications were noted. On average, preoperative VAS and SF-36 scores showed a tendency for improvement, whereas a dramatic reduction of VAS, by 65% (p = 0.003), was observed in radicular leg pain. CONCLUSIONS Patients with mild to moderate spinal deformity are often compensated and have tolerable levels of back pain. However, unilateral radicular pain resulting from foraminal stenosis can be debilitating. In select cases, an endoscopic discectomy or foraminotomy enables the surgeon to decompress the symptomatic foramen with preservation of essential biomechanical structures, delaying the need for a major deformity correction surgery.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity

Madhavan

Chieng

McGrath

et al. 2016

FOC

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“…1,10,14 While most studies have revealed either a higher complication rate or increased resource utilization, inferior clinical outcomes in obese patients have not been consistently demonstrated. 14,28 Despite the current lack of evidence, a tendency to favor less extensive, nonfusion procedures in obese patients is plausible given the historically higher postoperative complication rates associated with these patients. One possible reason for these higher rates could be that patients with higher BMIs are at risk for longer and more technically difficult procedures.…”

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confidence: 99%

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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“…26 Machino et al in two different papers, one 505 patients, the other 105 patients that underwent double-door laminoplasty for CSM, found worse pre-and post-operative Japanese Orthopaedic Assocaition ( JOA) scores, and slower, reduced improvement in patients with diabetes >10 years and HgbA1C>6.5%. 17,27 Dokai et al reported that, among CSM patients treated with ex- Table 3. Multivariate analysis for impact of diabetes on intra-and peri-operative patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy

et al. 2017

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Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

Cited by 96 publications

References 81 publications

Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity

Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy

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