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Vorster P, Matur AV, Palmisciano P, Conteh FS, Onyewadume L, Duah HO, Shukla GG, Chilakapati SS, Tao X, Gupta S, Shah S, Motley B, Cheng J, Virojanapa J, Adogwa O. Do Obese Patients Lose Weight After Lumbar Spine Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 175:122-129.e1. [PMID: 37059361 DOI: 10.1016/j.wneu.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Obesity is a major health care concern in the United States and is associated with high rates of postoperative complications after spine surgery. Obese patients assert that weight reduction is not possible unless spine surgery first relieves their pain and concomitant immobility. We describe the post-spine surgery effects on patient weight, with an emphasis on obesity. METHODS PubMed, EMBASE, Scopus, Web of Science, and Cochrane databases were systematically searched according to the PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (15 April 2022). Studies chosen for inclusion had to have data reporting on pre- and postoperative patient weight after spine surgery. Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. RESULTS Eight articles encompassing 7 retrospective and 1 prospective cohort were identified. A random effects model analysis demonstrated that overweight and obese patients (body mass index [BMI], >25 kg/m2) had increased odds of clinically significant weight loss after lumbar spine surgery compared with non-obese patients (odds ratio, 1.63; 95% confidence interval, 1.43-1.86, P < 0.0001). There was no significant difference in the raw weight change between BMI categories (mean difference, -0.67 kg, 95% confidence interval, -4.71 to 3.37 kg, P = 0.7463). CONCLUSIONS Compared with non-obese patients (BMI, <25 kg/m2), overweight and obese patients have higher odds of clinically significant weight loss after lumbar spine surgery. No difference in pre-operative and post-operative weight was found, although statistical power was lacking in this analysis. Randomized controlled trials and additional prospective cohorts are needed to further validate these findings.
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Affiliation(s)
- Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Fatu S Conteh
- Department of Neurosurgery, Loma Linda University Health, Loma Linda, California, USA
| | - Louisa Onyewadume
- School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Henry O Duah
- Department of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Virojanapa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Passias PG, Segreto FA, Imbo B, Williamson T, Joujon-Roche R, Tretiakov P, Krol O, Naessig S, Bortz CA, Horn SR, Ahmad W, Pierce K, Ihejirika YU, Lafage V. Defining age-adjusted spinopelvic alignment thresholds: should we integrate BMI? Spine Deform 2022; 10:1077-1084. [PMID: 35657561 DOI: 10.1007/s43390-022-00522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To develop age- and BMI-adjusted alignment targets to improve patient-specific management and operative treatment outcomes. METHODS Retrospective review of a single-center stereographic database. ASD patients receiving operative or non-operative treatment, ≥ 18y/o with complete baseline (BL) ODI scores and radiographic parameters (PT, SVA, PILL, TPA) were included. Patients were stratified by age consistent with US-Normative values (norms) of SF-36(< 35, 35-55, 45-54, 55-64, 65-74, ≥ 75y/o), and dichotomized by BMI (Non-Obese < 30; Obese ≥ 30). Linear regression analysis established normative age- and BMI-specific radiographic thresholds, utilizing previously published age-specific US-Normative ODI values converted from SF-36 PCS (Lafage et al.), in conjunction with BL age and BMI means. RESULTS 486 patients were included (Age: 52.5, Gender: 68.7%F, mean BMI: 26.2, mean ODI: 32.7), 135 of which were obese. Linear regression analysis developed age- and BMI-specific alignment thresholds, indicating PT, SVA, PILL, and TPA to increase with both increased age and increased BMI (all R > 0.5, p < 0.001). For non-obese patients, PT, SVA, PILL, and TPA ranged from 10.0, - 25.8, - 9.0, 3.1 in patients < 35y/o to 27.8, 53.4, 17.7, 25.8 in patients ≥ 75 y/o. Obese patients' PT, SVA, PILL, and TPA ranged from 10.5, - 7.6, - 7.1, 5.8 in patients < 35 y/o to 28.3, 67.0, 19.15, 27.7 in patients ≥ 75y/o. Normative SVA values in obese patients were consistently ≥ 10 mm greater compared to non-obese values, at all ages. CONCLUSION Significant associations exist between age, BMI, and sagittal alignment. While BMI influenced age-adjusted alignment norms for PT, SVA, PILL, and TPA at all ages, obesity most greatly influenced SVA, with normative values similar to non-obese patients who were 10 years older. Age-adjusted alignment thresholds should take BMI into account, calling for less rigorous alignment objectives in older and obese patients.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA. .,Division of Spinal Surgery, Department of Orthopaedic and Neurological Surgery, NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Bailey Imbo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Tyler Williamson
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Rachel Joujon-Roche
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Peter Tretiakov
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Oscar Krol
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Sara Naessig
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Waleed Ahmad
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Katherine Pierce
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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