Obesity does not significantly impact clinical outcomes following anterior cervical discectomy and fusion.

BACKGROUND

With obesity rates rising among patients undergoing anterior cervical discectomy and fusion (ACDF) and more procedures shifting to outpatient settings, this study aimed to evaluate the impact of body mass index (BMI) on complications, sagittal alignment, and patient-reported outcomes (PROs).

METHODS

A prospectively maintained database of 302 patients who underwent ACDF for myelopathy or radiculopathy between 2020 and 2022 at a single academic center was analyzed. Patients were stratified into four BMI categories: normal (18.5-<25), overweight (25-<30), obese class I (30-<35), and obese class II/III (≥35). Collected data included demographics, comorbidities, perioperative variables, radiographic measures (cSVA, Cobb angle, etc.), and PROs (VAS, NDI). Univariate regression compared demographics, alignment, and PROs, while multivariate analyses assessed complications and perioperative factors.

RESULTS

BMI was not independently associated with higher rates of postoperative complications, including adjacent segment disease, subsidence, reoperation, or other adverse events. Patients in the obese class II/III group had a modestly longer hospital stay (1.35 vs. 0.97 days, p = 0.030), likely reflecting greater baseline comorbidity burden. Cervical sagittal alignment parameters were comparable across BMI groups, and patient-reported outcomes, including pain and disability, showed no significant differences at any postoperative time point.

CONCLUSION

Elevated BMI does not appear to adversely affect surgical outcomes, complication rates, radiographic alignment, or patient-reported outcomes following ACDF. These findings suggest that high BMI should not be viewed as a contraindication to ACDF and that surgical decisions should prioritize overall clinical status rather than weight alone.