Rates of spinal disorders and procedures lower after bariatric surgery

Bariatric surgery lowered the rates of documented spinal disorders and procedures, as well as reducing the overall rate of healthcare encounters for patients with morbid obesity, according to US researchers. The findings were featured in the paper, ‘Bariatric Surgery Lowers Rates of Spinal Symptoms and Spinal Surgery in a Morbidly Obese Population’, published in Clinical Spine Surgery.

“In the present study we found that cervical, thoracic and lumbar spinal conditions, ranging from spondylosis to compression fractures, decreased significantly following bariatric surgery. These results held when controlling for age, sex, comorbidities and in a control group of morbidly obese with no history of bariatric procedures,” the authors reported. “Our findings suggest that, among the overweight and obese populations, many spinal disorders may be ameliorated or frankly obviated through bariatric surgery-induced weight loss.”


The researchers stated that although bariatric surgery has been found to improve weight loss outcomes and weight associated comorbidities, whether it impacts the rates of spine surgery and effects spine-related conditions remains largely unknown. As a result, they designed a study to assess impact of surgery on reported spinal disorders. In their retrospective analysis using New York State Inpatient Database years 2004–2013, they compared reported rates for spinal conditions before and after bariatric surgery, as well as examining the potential impact of surgery on rates of surgical intervention for spine-related disorders.


A total of 73,046 bariatric patients were included in the study included (age 67.88±17.66, 56.1% female) and for regression analysis, 299,504 non-bariatric patient with morbid obesity were included (age 53.45±16.52, 65.6% female). The most common bariatric surgeries performed were gastrectomy (73.9%), laparoscopic sleeve gastrectomy (65.9%), and gastric band with gastric bypass (19.9%).


Outcomes

Overall, rates of spinal symptoms decreased following surgery (7.40%–5.14%, P<0.001). Cervical, thoracic, lumbar spine diagnoses rates dropped from 3.28% to 2.99%, 2.91% to 2.57%, and 5.39% to 3.92% (all p<0.001), respectively. The most marked reductions were reported in cervical spontaneous compression fractures, cervical disc herniation, thoracic radicular pain, spontaneous lumbar compression fractures, lumbar spinal stenosis, lumbar spondylosis. Controlling for comorbidities, age and sex, obese non-bariatric patients more likely to have encounters associated with several cervical, thoracic or lumbar spinal diagnoses and procedures, especially for cervical spontaneous compression fracture, radicular pain, lumbar spondylosis, lumbar spinal stenosis, posterior procedures.

Overall, 77.1% of patients with a spinal disorder before bariatric surgery that became asymptomatic following bariatric surgery had this complaint disappear between two months and two years after the bariatric surgery. The rate of encounters for cervical spine disorders decreased from 3.28% to 2.99% (p<0.001), with the most marked reductions in cervical spontaneous compression fractures (1.14%–0.78%), cervical disc herniation (0.44%–0.30%), and cervical spondylosis with myelopathy (0.38%–0.21%, all p<0.001).


In addition, thoracic diagnoses also decreased after bariatric surgery from 2.91% to 2.57%, most commonly thoracic radicular pain (0.46%–0.27%), and spontaneous thoracic compression fracture (1.14%–0.78%, all p<0.001). Encounters for lumbar disorders also decreased after surgery (5.39%–3.92%), with substantial reductions in events associated with lumbar compression fractures (1.14%–0.68%), lumbar spinal stenosis (1.41%–0.68%) and lumbar spondylosis (0.87%–0.47%, all p<0.001). Rates of spine surgery in bariatric patients were low overall, but significantly decreased following bariatric surgery, including all posterior fusions (0.88%–0.57%), anterior fusions (1.05%–0.57%), and decompression procedures (1.55%–0.85%, all p<0.001).


Whilst the authors acknowledged that it is unlikely that bariatric surgery is resulting in any structural changes to the degenerative spine, the subsequent improvements in BMI and reduced systemic inflammation associated with weight loss are leading to these underlying disorders proving less symptomatic. Therefore, they stated that bariatric surgery for qualifying individuals should be considered before recommendations for elective spine surgical interventions, as in some cases this may negate the need for spine surgery and in others the surgery itself may be rendered safer and less likely to result in postsurgical morbidity.

“These findings support the value of bariatric surgery as a means to reduce the need for spine surgical interventions overall, while simultaneously rendering those that are necessary less prone to postsurgical complications,” they concluded.

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