Individuals with obesity can have a high burden of comorbidities, including degenerative spinal conditions. A study published in Acta Neurochirurgica showed patients with a history of bariatric surgery had lower overall complication rates after spinal surgery than morbidly obese patients who had not undergone bariatric surgery.
Andrew J. Schoenfeld, MD, a spinal surgery specialist in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, joined the research team in building on those findings. In Clinical Spine Surgery, he and his colleagues report significant reductions in symptomatic spinal disorders and the need for spinal surgery after bariatric surgery.
Using the New York State Inpatient Database, the researchers identified 73,046 morbidly obese adults who underwent bariatric surgery and a control group of 299,504 morbidly obese adults who did not. All patients were tracked for 10 years, from 2004 to 2013, to assess any occurrence of spinal complaints and/or spinal surgery.
Overall rates of spinal disorders decreased from 7.40% before bariatric surgery to 5.14% afterward (P<0.001). The most marked reductions were in (all P<0.001):
- Cervical spontaneous compression fractures (rate of encounters decreased from 1.14% before bariatric surgery to 0.78% afterward)
- Cervical disc herniation (0.44%–0.30%)
- Cervical spondylosis with myelopathy (0.38%–0.21%)
- Thoracic radicular pain (0.46%–0.27%)
- Spontaneous thoracic compression fractures (1.14%–0.78%)
- Lumbar compression fractures (1.14%–0.68%)
- Lumbar spinal stenosis (1.41%–0.68%)
- Lumbar spondylosis (0.87%–0.47%)
Rates of spinal surgery also significantly decreased after bariatric surgery, including (all P<0.001):
- Posterior fusions (rate decreased from 0.88% before bariatric surgery to 0.57% afterward)
- Anterior fusions (1.05%–0.57%)
- Decompression procedures (1.55%–0.85%)
In multivariable logistic regression analysis, the control group was more likely than the bariatric surgery group to have encounters associated with spinal disorders. This was especially true for cervical spontaneous compression fracture, thoracic radicular pain, thoracic fracture, and posterior procedures.
Bariatric surgery significantly lowered rates of other obesity-related comorbidities: hypertension, hypercholesterolemia, musculoskeletal conditions, asthma, osteoarthritis, uncontrolled diabetes, and rheumatoid arthritis.
Applying the Results to Practice
Based on these results, the researchers advise consideration of bariatric surgery for qualifying individuals before elective spinal surgery is recommended. In some cases, the need for spinal surgery may be eliminated after bariatric surgery, and in others, the surgery may be less likely to result in postsurgical morbidity.
A caveat is that bariatric surgery can have long-term negative adverse effects on bone health, and this should be considered in the risk–benefit analysis about offering bariatric surgery before spinal surgery.