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

Dennis S Meredith¹, Russel C Huang, Joseph Nguyen

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

The Spine Journal : Official Journal of the North American Spine Society

|March 30, 2010

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.

Insights

Obesity significantly increases the risk of recurrent herniation of the nucleus pulposus (HNP) after lumbar microdiscectomy. Obese patients are 12 times more likely to experience recurrent HNP and 30 times more likely to require reoperation.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Recurrent herniation of the nucleus pulposus (HNP) after lumbar discectomy is associated with poor patient outcomes.
The impact of obesity on recurrent HNP has not been previously established.

Purpose of the Study:

To investigate the association between obesity and recurrent HNP following lumbar microdiscectomy.
To determine if obesity is an independent risk factor for recurrent HNP.

Main Methods:

Retrospective cohort study of patients undergoing lumbar microdiscectomy.
Analysis of 75 patients with a minimum 6-month follow-up.
Primary outcomes included recurrent HNP on MRI and need for reoperation.

Main Results:

Obese patients (BMI ≥30) had a significantly higher mean BMI compared to non-obese patients (33.6 vs. 26.9).
Obese patients were 12 times more likely to have recurrent HNP (OR: 12.46) and 30 times more likely to require reoperation (OR: 32.81).
Logistic regression and Cox proportional hazards models confirmed obesity as a significant predictor (HR: 17.08).

Conclusions:

Obesity is a strong, independent predictor of recurrent HNP after lumbar microdiscectomy.
Preoperative weight loss counseling is recommended for patients undergoing lumbar discectomy.

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