Low back pain, disability and sagittal alignment of obese patients before and after bariatric surgery: A comparative study.

STUDY

DESIGN

Retrospective analysis of prospectively collected data.

OBJECTIVE

This study compared low back pain, patient-reported outcome measures (PROMs), and sagittal alignment in a cohort of obese patients before and after BS.

BACKGROUND

Many studies suggest that bariatric surgery (BS) has a positive impact on improving low back pain and decreasing disability. However, there are no studies describing global sagittal balance before and after BS.

METHODS

A cohort of 41 obese patients with1 year follow up after BS in a single center. The extracted data consisted of baseline demographics and characteristics, Numerical Rating Scale (NRS) for back and leg pain, PROMs (Short Form 12 (SF12) score, Oswestry Disability Index (ODI) scores and Quebec score), and radiographic parameters.

RESULTS

Patients undergoing BS had a significant reduction in weight, and BMI at 1 year post-operatively. In addition, there was a significant reduction in the number of patients having back pain (66 % vs 17 %, p < .001). In fact, the back and leg NRS scores improved significantly 1 year post-operatively (3.8 ± 2.6 vs 1.2 ± 1.9, p < .001; 3.8 ± 2.0 vs 3.0 ± 1.4, p < .001, respectively) as did both ODI and PCS-SF12. As for radiographic parameters, there was a decrease in sacral slope (39.0 ± 10.0 vs 36.9 ± 9.0, p < 0.05) alongside the number of vertebras in lumbar lordosis (7.4 ± 1.5 vs 7.0 ± 1.2, p < 0.01), and an increase in quebe the mean disc-height of both L4-L5 (0.28 ± 0.06 vs 0.32 ± 0.06, p < 0.01) and L5-S1 (0.26 ± 0.07 vs 0.30 ± 0.08, p < 0.01).

CONCLUSION

This study demonstrates that BS significantly reduces low back pain and improves function in obese patients, making it a compelling alternative to spinal surgery in morbidly obese patients suffering from back pain. It also supports the mechanical theory linking excess weight to disc-degeneration.