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Spine J. 2010 Jul;10(7):575-80. doi: 10.1016/j.spinee.2010.02.021. Epub 2010 Mar 27.

Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy.

Author information

1
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. meredithd@hss.edu

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.

PMID:
20347400
DOI:
10.1016/j.spinee.2010.02.021
[Indexed for MEDLINE]

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