Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Academic Article uri icon

Overview

abstract

  • BACKGROUND CONTEXT: Recurrent herniation of the nucleus pulposus (HNP) frequently causes poor outcomes after lumbar discectomy. The relationship between obesity and recurrent HNP has not previously been reported. PURPOSE: The purpose of this study was to investigate the association of obesity with recurrent HNP after lumbar microdiscectomy. STUDY DESIGN: Retrospective Cohort. PATIENT SAMPLE: We reviewed all cases of one- or two-level lumbar microdiscectomy from L2-S1 performed by a single surgeon with a minimum follow-up of 6 months. OUTCOME MEASURES: The primary clinical outcomes were evidence of recurrent HNP on magnetic resonance imaging (MRI) and need for repeat surgery. METHODS: All patients with recurrent radicular pain or new neurological deficits underwent a postoperative MRI scan. Recurrent HNP was defined as a HNP at the same side and same level as the index procedure. RESULTS: Seventy-five patients were included in the study. The average body mass index (BMI) was 27.6+/-4.6. Thirty-two patients received an MRI scan. The time from operation to repeat MRI scan varied widely (3 days to 15 months). Eight patients (10.7%) had recurrent HNP. Four patients had persistent symptoms requiring reoperation (5.3%). The mean BMI of patients with recurrent HNP was significantly higher than that of those without recurrence (33.6+/-5.1 vs. 26.9+/-3.9, p<.001). In univariate analysis, obese patients (BMI >or=30) were 12 times more likely to have recurrent HNP than nonobese patients (odds ratio [OR]: 12.46, 95% confidence interval [CI]: 2.25-69.90). Obese patients were 30 times more likely to require reoperation (OR: 32.81, 95% CI: 1.67-642.70). Age, sex, smoking, and being a manual laborer were not significantly associated with recurrent HNP. A logistic regression analysis supported the findings of the univariate analysis. In a survival analysis using a Cox proportional hazards model, the hazard ratio of recurrent HNP for obese patients was 17 (OR: 17.08, 95% CI: 2.85-102.30, p=.002). CONCLUSIONS: Obesity was a strong and independent predictor of recurrent HNP after lumbar microdiscectomy. Surgeons should incorporate weight loss counseling into their preoperative discussions with patients.

publication date

  • March 27, 2010

Research

keywords

  • Diskectomy
  • Intervertebral Disc Displacement
  • Lumbar Vertebrae
  • Obesity
  • Postoperative Complications

Identity

Scopus Document Identifier

  • 77953610793

Digital Object Identifier (DOI)

  • 10.1016/j.spinee.2010.02.021

PubMed ID

  • 20347400

Additional Document Info

volume

  • 10

issue

  • 7