EFFECT OF BODY MASS INDEX ON OUTCOME OF POSTERIOR 360° FUSION FOR SINGLE-LEVEL LUM BAR DEGENERATIVE DISEASES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANGSheng , LUOJiaquan , LILiangping , QIQihua , LIUShaoyu , WANYong , PENGXinsheng ,  ZOUXuenong

Department of Spinal Surgery, Orthopaedic Research Institute, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;

Corresponding author：

ZOUXuenong, Email: zxnong@hotmail.com

Keywords：

Lumbar disc herniation; Lumbar spinal stenosis; Lumbar instability; 360°; fusion; Body mass index

DOI：

10.7507/1002-1892.20160040

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Objective To investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. Methods A retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m²) in 105 cases (group A), overweight (24 kg/m²≤BMI< 28 kg/m²) in 108 cases (group B), and obese (BMI≥28 kg/m²) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). Results The operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ²=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). Conclusion Posterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m² have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.

Citation： HUANGSheng, LUOJiaquan, LILiangping, QIQihua, LIUShaoyu, WANYong, PENGXinsheng, ZOUXuenong. EFFECT OF BODY MASS INDEX ON OUTCOME OF POSTERIOR 360° FUSION FOR SINGLE-LEVEL LUM BAR DEGENERATIVE DISEASES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 197-201. doi: 10.7507/1002-1892.20160040 Copy

1.	Wu Y. Overweight and obesity in China. BMJ, 2006, 333(7564):362-363.
2.	Bridwell KH, Lenke LG, Mcenery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12):1410-1418.
3.	Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980:systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet, 2011, 377(9765):557-567.
4.	Liuke M, Solovieva S, Lamminen A, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond), 2005, 29(8):903-908.
5.	Gandhi R, Woo KM, Zywiel MG, et al. Metabolic syndrome increases the prevalence of spine osteoarthritis. Orthop Surg, 2014, 6(1):23-27.
6.	Romero-Vargas S, Zarate-Kalfopulos B, Otero-Camara E, et al. The impact of body mass index and central obesity on the spino-pelvic parameters:a correlation study. Eur Spine J, 2013, 22(4):878-882.
7.	顾广飞, 张海龙, 贺石生, 等. 体重指数对微创手术治疗单节段腰椎管狭窄症并腰椎不稳疗效的影响. 中国脊柱脊髓杂志, 2012, 22(4):313-317.
8.	Gepstein R, Shabat S, Arinzon ZH, et al. Does obesity affect the results of lumbar decompressive spinal surgery in the elderly? Clin Orthop Relat Res, 2004, (426):138-144.
9.	Andreshak TG, An HS, Hall J, et al. Lumbar spine surgery in the obese patient. J Spinal Disord, 1997, 10(5):376-379.
10.	Hanigan WC, Elwood PW, Henderson JP, et al. Surgical results in obese patients with sciatica. Neurosurgery, 1987, 20(6):896-899.
11.	Knutsson B, Michaelsson K, Sanden B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis:a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976), 2013, 38(5):435-441.
12.	Giannadakis C, Nerland US, Solheim O, et al. Does Obesity Affect Outcomes After Decompressive Surgery for Lumbar Spinal Stenosis? A Multicenter, Observational, Registry-Based Study. World Neurosurg, 2015, 84(5):1227-1234.
13.	Rihn JA, Kurd M, Hilibrand AS, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation:analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg (Am), 2013, 95(1):1-8.
14.	Rihn JA, Radcliff K, Hilibrand AS, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976), 2012, 37(23):1933-1946.
15.	De la Garza-Ramos R, Bydon M, Abt NB, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976), 2015, 40(1):56-61.
16.	Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res, 2014, 472(3):968-975.
17.	Mcguire KJ, Khaleel MA, Rihn JA, et al. The effect of high obesity on outcomes of treatment for lumbar spinal conditions:subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014, 39(23):1975-1980.
18.	Lingutla KK, Pollock R, Benomran E, et al. Outcome of lumbar spinal fusion surgery in obese patients:a systematic review and meta-analysis. Bone Joint J, 2015, 97-B(10):1395-1404.
19.	Goldin AN, Alander DH. Effect of body mass index on early outcomes of minimally invasive degenerative lumbar surgery. J Surg Orthop Adv, 2015, 24(1):12-17.
20.	Shamji MF, Parker S, Cook C, et al. Impact of body habitus on perioperative morbidity associated with fusion of the thoracolumbar and lumbar spine. Neurosurgery, 2009, 65(3):490-498.
21.	Koutsoumbelis S, Hughes AP, Girardi FP, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg (Am), 2011, 93(17):1627-1633.
22.	Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg, 2003, 98(2 Suppl):149-155.
23.	Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery:relation to perioperative complications. J Neurosurg Spine, 2007, 6(4):291-297.
24.	Djurasovic M, Bratcher KR, Glassman SD, et al. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976), 2008, 33(16):1789-1792.
25.	Abdallah DY, Jadaan MM, Mccabe JP. Body mass index and risk of surgical site infection following spine surgery:a meta-analysis. Eur Spine J, 2013, 22(12):2800-2809.
26.	Gaudelli C, Thomas K. Obesity and early reoperation rate after elective lumbar spine surgery:a population-based study. Evid Based Spine Care J, 2012, 3(2):11-16.
27.	Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127:112-115.

1. Wu Y. Overweight and obesity in China. BMJ, 2006, 333(7564):362-363.
2. Bridwell KH, Lenke LG, Mcenery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12):1410-1418.
3. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980:systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet, 2011, 377(9765):557-567.
4. Liuke M, Solovieva S, Lamminen A, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond), 2005, 29(8):903-908.
5. Gandhi R, Woo KM, Zywiel MG, et al. Metabolic syndrome increases the prevalence of spine osteoarthritis. Orthop Surg, 2014, 6(1):23-27.
6. Romero-Vargas S, Zarate-Kalfopulos B, Otero-Camara E, et al. The impact of body mass index and central obesity on the spino-pelvic parameters:a correlation study. Eur Spine J, 2013, 22(4):878-882.
7. 顾广飞, 张海龙, 贺石生, 等. 体重指数对微创手术治疗单节段腰椎管狭窄症并腰椎不稳疗效的影响. 中国脊柱脊髓杂志, 2012, 22(4):313-317.
8. Gepstein R, Shabat S, Arinzon ZH, et al. Does obesity affect the results of lumbar decompressive spinal surgery in the elderly? Clin Orthop Relat Res, 2004, (426):138-144.
9. Andreshak TG, An HS, Hall J, et al. Lumbar spine surgery in the obese patient. J Spinal Disord, 1997, 10(5):376-379.
10. Hanigan WC, Elwood PW, Henderson JP, et al. Surgical results in obese patients with sciatica. Neurosurgery, 1987, 20(6):896-899.
11. Knutsson B, Michaelsson K, Sanden B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis:a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976), 2013, 38(5):435-441.
12. Giannadakis C, Nerland US, Solheim O, et al. Does Obesity Affect Outcomes After Decompressive Surgery for Lumbar Spinal Stenosis? A Multicenter, Observational, Registry-Based Study. World Neurosurg, 2015, 84(5):1227-1234.
13. Rihn JA, Kurd M, Hilibrand AS, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation:analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg (Am), 2013, 95(1):1-8.
14. Rihn JA, Radcliff K, Hilibrand AS, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976), 2012, 37(23):1933-1946.
15. De la Garza-Ramos R, Bydon M, Abt NB, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976), 2015, 40(1):56-61.
16. Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res, 2014, 472(3):968-975.
17. Mcguire KJ, Khaleel MA, Rihn JA, et al. The effect of high obesity on outcomes of treatment for lumbar spinal conditions:subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014, 39(23):1975-1980.
18. Lingutla KK, Pollock R, Benomran E, et al. Outcome of lumbar spinal fusion surgery in obese patients:a systematic review and meta-analysis. Bone Joint J, 2015, 97-B(10):1395-1404.
19. Goldin AN, Alander DH. Effect of body mass index on early outcomes of minimally invasive degenerative lumbar surgery. J Surg Orthop Adv, 2015, 24(1):12-17.
20. Shamji MF, Parker S, Cook C, et al. Impact of body habitus on perioperative morbidity associated with fusion of the thoracolumbar and lumbar spine. Neurosurgery, 2009, 65(3):490-498.
21. Koutsoumbelis S, Hughes AP, Girardi FP, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg (Am), 2011, 93(17):1627-1633.
22. Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg, 2003, 98(2 Suppl):149-155.
23. Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery:relation to perioperative complications. J Neurosurg Spine, 2007, 6(4):291-297.
24. Djurasovic M, Bratcher KR, Glassman SD, et al. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976), 2008, 33(16):1789-1792.
25. Abdallah DY, Jadaan MM, Mccabe JP. Body mass index and risk of surgical site infection following spine surgery:a meta-analysis. Eur Spine J, 2013, 22(12):2800-2809.
26. Gaudelli C, Thomas K. Obesity and early reoperation rate after elective lumbar spine surgery:a population-based study. Evid Based Spine Care J, 2012, 3(2):11-16.
27. Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127:112-115.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF BODY MASS INDEX ON OUTCOME OF POSTERIOR 360° FUSION FOR SINGLE-LEVEL LUM BAR DEGENERATIVE DISEASES

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