In many cases, spine surgeons working with obese patients considering lumbar fusion surgery will suggest that they first undergo bariatric weight loss surgery.
This recommendation is based on a general understanding that obesity leads to serious health issues, and that a patient with a lower Body Mass Index is healthier and better able to tolerate and recover from the surgery.
Now a new study is questioning this conventional wisdom and suggesting that the exact opposite may be true. Researcher Woojin Cho of the Montefiore Medical Center/University Hospital for Albert Einstein College of Medicine in New York has just presented his findings to the 25th International Meeting on Advanced Spine Techniques, showing that patients who have bariatric surgery before lumbar fusion surgery are at greater risk for post-surgical complications.
Every patient is different, and patients who are obese and who are also considering spinal surgery should discuss their personal care plan with their physician, but Cho’s research represents a sea change in the instructions that spine surgeons offer their patients.
Cho’s team reviewed the outcomes of nearly 40,000 spinal fusion patients who had surgery between 2005 and 2015, drawing their information from the National Surgical Quality Improvement Program dataset. By matching patients with similar BMIs and separating out for those who had experienced a weight loss of more than 10% of their body weight in the six months prior to their spinal surgery, they were able to determine that massive body weight losses before back surgery were linked to worse post-operative outcomes, including longer hospital stays and greater risk of surgical site infections and deep vein thrombosis.
The study was careful to use characteristics such as age, sex, smoking status as a control and to eliminate those who had outlying health issues from their research. The difference in serious outcomes was more than significant: those who had undergone the weight loss surgery prior to their lumbar fusion surgery actually had more than twice the number of complications compared to the group that had not undergone the weight loss surgery.
Reviewing the study’s finding, Cho and his group determined that the cause of the increased number of complications following lumbar fusion surgery had nothing to do with the surgery itself: rather it was an issue of nutritional deficiencies that followed the bariatric surgery.
Because the extreme weight loss surgery dramatically reduces the amount of food that the patient takes in, and can sometimes impact the body’s ability to absorb both macro and micro nutrients, the researchers conclude that patients should either have their lumbar fusion surgery first or make sure that they are getting adequate nutrition through supplementation, with a focus on Vitamins A, D, B6 and B12, protein, folate, zinc and iron.
If you are a candidate for both bariatric surgery and lumbar fusion surgery, it is essential that you have an in-depth conversation with your spine specialist as to the best way to approach your weight loss goals. For more information, contact us to set up an appointment.