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The impact of obesity on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS): A swiss prospective multicenter cohort study


Burgstaller, J M; Held, U; Brunner, Florian; Porchet, F; Farshad, Mazda; Steurer, J; Ulrich, N H (2016). The impact of obesity on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS): A swiss prospective multicenter cohort study. Spine, 41(1):82-89.

Abstract

STUDY DESIGN: Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland.
OBJECTIVE: The aim of the study was to assess whether obese patients benefit after decompression surgery for degenerative lumbar spinal stenosis (DLSS).
SUMMARY AND BACKGROUND DATA: Lumbar decompression surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar decompression in the obese population remains controversial.
METHODS: Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome.
RESULTS: Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up.
CONCLUSION: Obese patients can expect clinical improvement after lumbar decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.

Abstract

STUDY DESIGN: Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland.
OBJECTIVE: The aim of the study was to assess whether obese patients benefit after decompression surgery for degenerative lumbar spinal stenosis (DLSS).
SUMMARY AND BACKGROUND DATA: Lumbar decompression surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar decompression in the obese population remains controversial.
METHODS: Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome.
RESULTS: Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up.
CONCLUSION: Obese patients can expect clinical improvement after lumbar decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 January 2016
Deposited On:02 Feb 2017 09:52
Last Modified:03 Feb 2017 04:11
Publisher:Lippincott Williams & Wilkins
ISSN:0362-2436
Publisher DOI:https://doi.org/10.1097/BRS.0000000000001128
PubMed ID:26689396

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