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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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The impact of obesity on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: A Swiss prospective cohort multicenter study

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  • Nils H. Ulrich - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Switzerland; Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
  • Ulrike Held - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Switzerland
  • Mazda Farshad - Department of Orthopedics, University Hospital Balgrist, University of Zurich, Switzerland
  • Johann Steurer - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Switzerland
  • Jakob M. Burgstaller - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Switzerland
  • François Porchet - Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 111

doi: 10.3205/16dgnc486, urn:nbn:de:0183-16dgnc4868

Published: June 8, 2016

© 2016 Ulrich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To examine whether obese patients benefit after decompression surgery for degenerative lumbar spinal canals stenosis (DLSS). Lumbar decompression surgery has been shown to improve quality of life in lumbar spinal canal stenosis. However, this remains a matter of debate in the existing literature concerning the obese population. This is a prospective, multicenter cohort study including eight medical centers in the metropolitan area of Zurich, Switzerland.

Method: Eight centers participated in the LSOS study. Baseline patient characteristics and outcomes were analyzed at 6 months 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 scale (RMDS). Body mass index (BMI) was classified into three categories according to WHO. Odds ratios for meaningful clinical important difference (MCIDs) in SSM were estimated for different BMI categories.

Results: Of the 656 patients in the LSOS database as of end of October 2014, one hundred and eighty-six patients met the inclusion criteria. Fifty-seven had a BMI <25 (underweight and normal weight group), seventy-eight had a BMI between 25 - 29.9 (pre-obesity group) and 51 patients had a BMI ≥30 (obese group). We found for the primary outcome that in obese patients 35 % reached MCID in SSM at six months, and 45% at 12 months. The estimated odds ratios for MCID in the obese group were 0.68 (0.31-1.49) at 6 months and 0.84 (0.39-1.79) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the secondary outcome SSM, NRS, FT and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up.

Conclusions: Obese patients can expect clinical improvement after lumbar decompression for symptomatic DLSS, but the percentage of patients with MCID is lower than in the group of patients with under-, normal and pre-obese weight at 6 and 12 months.