The obesity epidemic makes life difficult for patients with herniated lumbar discs – and for back-surgeons: Increased risk of complications
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Frode Kolstad
In this issue of the Scandinavian Journal of Pain, Järvimäki et al. focus on problems and complications arising in pre-obese and obese patients who need back surgery, discectomy in particular [1].The epidemic of obesity has reached the Nordic countries, and for persons above 60 years of age, Western Europe has prevalence about 20% for men and about 30% for women [2].
Excess bodyweight is among the highest risk factors for increased burden of disease globally, contributing to development of ischaemic heart disease, hypertension, osteoarthritis, diabetes mellitus, and stroke, cancer of the colon, breast and endometrium [2]. In their survey of lumbar discectomy patients, Järvimäki et al. found that outcomes of surgery with respect to functional disability, depressed mood, and social activities were worse among those with BMI in the obese category (BMI >30kg/m2) [1]. Both the preobese (BMI >25 and <30) and the obese patients gained weight during the postoperative follow-up time of about 2 years.
It is almost self-evident that technical difficulties for the surgeon doing minimally invasive discectomies will be more severe when operating on an obese patient compare with a non-obese patient. This may be the reason for a higher prevalence of reopera-tions among their obese patients [1]. Postoperative complications and cost significantly increase compared with none-obese patients [3]. Similarly, the anaesthesia team will have more challenges anesthetizing an obese patient; turning an obese patient under full general anaesthesia to the prone position is also not a trivial undertaking. The increased costs are due to longer operating time, longer anaesthesia time, more often admission to the intensive care unit as well as longer hospital stay [3].
We therefore agree hole-heartily with Järvimäki et al. [1] that obese patients with prolapsed lumbar disc must be helped lose weight before elective surgery. It may even be easier to motivate the patient to do a serious attempt at losing weight when they can be promised a better outcome of a necessary operative discectomy.
After a successive discectomy, the reduced burden of pain must be exploited for a continuing weight loss and encouragement to increase their physical activity. An individualized and prolonged postoperative physiotherapy regimen should contribute significantly to motivation and success of physical training. This will ensure a longer benefit after their successful discectomy.
If the patients continue to gain weight, as the obese patients of Järvimäki did during the two years following their discectomy [1], and continue to remain physically passive, their overall risk of ill health, mental depression, and low quality of life will continue. If they cannot lose weight and they cannot be physically more active, the high risks of developing one or more of the serious chronic diseases (see above) looming in the future of obese patients will not be reduced by a discectomy [1, 2].
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2015.10.003.
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Conflict of interest: None declared.
References
[1] Järvimäki V, Kautiainen H, Haanpää M, Alahuhta S, Vakkala M. Obesity has an impact on outcome in lumbar disc surgery. Scand J Pain 2016;10:85–9.Suche in Google Scholar
[2] Haslam DW, James WP. Obesity. Lancet 2005;366:1197–209.Suche in Google Scholar
[3] Planchard RF, Higgins DM, Mallory GW, Puffer RC, Jacob JT, Curry TB, Kor DJ, Clarke MJ. The impact of obesity on perioperative resource utilization after elective spine surgery for degenerative disease. Glob Spine J 2015;5:287–93, http://dx.doi.org/10.1055/s-0035-1546819 [Epub 2015 March 4].Suche in Google Scholar
© 2015 Scandinavian Association for the Study of Pain
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