The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation

Rihn, Jeffrey A.; Kurd, Mark F.; Hilibrand, Alan S.; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd J.; Weinstein, James Neil

doi:10.2106/jbjs.k.01558

Cited by 162 publications

(118 citation statements)

References 31 publications

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“…One limitation of the SPORT, and therefore this study, is the high crossover rate observed between the operative and nonoperative groups. However, because previous authors found consistencies between cohorts, the data have been combined into an as-treated analysis in many of the studies included in this review [3,5,6,8,9,11,[14][15][16][17][18]. Also, the 8-year followup rate was 63% of the initial subjects, and baseline demographics tended to be favorable to a better outcome in both the surgical and nonoperative groups [10].…”

Section: Discussionmentioning

confidence: 99%

“…Search criteria included ''SPORT'' AND ''disc'' AND ''Spine Patients Outcomes Research Trial,'' which returned 36 articles. Of these, we identified 11 articles that analyzed subgroups of the SPORT patients with IDH [3,5,6,8,9,11,[14][15][16][17][18] (Table 1). A listing of SPORT-related Table 1.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…The patient factors [18]. At 2-year followup, based on herniation location and morphology, there were no differences in treatment effects of surgery (back pain bothersomeness) (p = 0.62 and p = 0.82, respectively) [14] (Table 3).…”

Section: Factors Associated With Improvement In Patientreported Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Koerner

Glaser

Radcliff

2015

Clinical Orthopaedics &Amp; Related Research

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Background The Spine Patient Outcomes Research Trial (SPORT) evaluated the effects of surgery versus nonoperative treatment for lumbar intervertebral disc herniation (IDH), among other pathologies. Multiple subgroup analyses have been completed since the initial publications, which have further defined which patient factors lead to better or worse patient-reported outcomes; however, the degree to which these factors influence patient-reported outcomes has not been explored. Questions/purposes We reviewed the subgroup analyses of the SPORT IDH studies to answer the following questions: (1) What factors predicted improvement in patientreported outcomes after operative or nonoperative treatment of lumbar IDH? (2) What factors predicted worse patient-reported outcomes compared to baseline after operative or nonoperative treatment of lumbar IDH? And (3) what factors influenced patient-reported outcomes of surgery in patients with lumbar IDH? Methods We conducted a MEDLINE 1 search to identify the subgroup analyses of the SPORT IDH data that were responsive to our study questions. Eleven articles were identified that met our search criteria. Results The patient factors associated with larger improvements in Oswestry Disability Index at 4 years with either surgical or nonoperative treatment included a higher baseline Oswestry Disability Index, BMI of less than 30, not being depressed, being insured, having no litigation pending, not having workers compensation, and having symptoms for less than 6 weeks, though there were others. Factors leading to improvement with surgical treatment were mostly related to anatomic characteristics of the disc herniation such as posterolateral and sequestered herniations. There were no patient or clinical factors identified that were associated with worse patient-reported outcomes compared to baseline after either operative or nonoperative treatment. At 2-year followup, the treatment effects were greater for those patients with upper-level herniations, patients not receiving workers compensation, and nondiabetic patients. In a 4-year multivariate analysis, being married, without joint problems, and having worse symptoms at baseline resulted in greater treatment effect with surgery. Conclusions While most patients with IDH will likely see improvement with either surgical or nonoperative treatment, there are patient-related factors that can help predict which subgroups will demonstrate a greater improvement with surgery, such as not having joint problems, being married, having worsening symptoms at baseline, and not having diabetes. These results can help providers and patients when discussing treatment options.

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Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Koerner

Glaser

Radcliff

2015

Clinical Orthopaedics &Amp; Related Research

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“…Some studies reported that obesity has been associated with unfavorable surgical outcomes such as longer operative times, greater operative blood loss, and a higher rate of revision for patients having spinal surgery [10,14,31,32,35,39]. However, other studies did not find significant differences regarding surgical outcome and complications between patients who were obese or not obese [2,5,9,26].…”

Section: Introductionmentioning

confidence: 99%

Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

Jiang

Teng

Fan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

170

130

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Background As obesity becomes more prevalent, it becomes more common among patients considering orthopaedic surgery, including spinal surgery. However, there is some controversy regarding whether obesity is associated with complications, failed reconstructions, or reoperations after spinal surgery. Questions/purposes We wished to determine, in patients undergoing spine surgery, whether obesity is associated with (1) surgical site infection, (2) mortality and the need for revision surgery after spinal surgery, and (3) increased surgical time and blood loss. Methods A systematic literature search was performed to collect comparative or controlled studies that evaluated the influence of obesity on the surgical and postoperative outcomes of spinal surgery. Two reviewers independently selected trials, extracted data, and assessed the methodologic quality and quality of evidence. Pooled odds ratios (OR) and mean differences (MD) with 95% CIs were calculated using the fixed-effects model or random-effects model. Data were analyzed using RevMan 5.1. MOOSE criteria were used to ensure this project's validity. Thirtytwo studies involving 97,326 patients eventually were included. Results Surgical site infection (OR, 2.33; 95% CI, 1.94-2.79), venous thromboembolism (OR, 3.15; 95% CI, 1.92-5.17), mortality (OR, 2.6; 95% CI, 1.50-4.49), revision rate (OR, 1.43; 95% CI, 1.05-1.93) operating time (OR, 14.55; 95% CI,, and blood loss (MD, 28.89; 95% CI,, were all significantly increased in the obese group. Conclusion Obesity seemed to be associated with higher risk of surgical site infection and venous thromboembolism, more blood loss, and longer surgical time. Future prospective studies are needed to confirm the relationship between obesity and the outcome of spinal surgery.

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“…This was true in both the operative (lumbar microdiscectomy) and non-operative arms. Additionally, obese patients that were managed operatively demonstrated significantly less improvement and lower final follow up values in the Sciatica Bothersomeness and Low Back Pain Bothersomeness Indices [42]. Though seemingly at odds with other clinical studies [12,20,[34][35][36], this as-treated analysis of the SPORT study has the benefit of a prospective design with large samples from multiple geographic locals and medical centers and long-term follow up which affords favorable generalizability of its results to true values expected in clinical practice.…”

Section: Discussionmentioning

confidence: 90%

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

McAnany¹,

Overley²,

Andelman³

et al. 2015

Integr Obesity Diabetes

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The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation

Abstract: Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients.

Cited by 162 publications

References 31 publications

Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

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