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Does BMI Impact Spinopelvic Alignment After Lumbar Fusion Surgery?
Jonathan Dalton1, Ali Farooqi, Teeto Ezeonu
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Spine
|April 21, 2025
Summary
Elevated body mass index (BMI) is linked to poorer sagittal alignment after lumbar fusion surgery. Higher BMI independently predicts failure to achieve ideal long-term spinopelvic parameters post-surgery.
Area of Science:
- Spine surgery
- Orthopedics
- Biomedical engineering
Background:
- Sagittal malalignment impacts outcomes after spine deformity fusion.
- The role of elevated body mass index (BMI) in achieving and maintaining postoperative spinopelvic parameters is not well understood.
Purpose of the Study:
- To evaluate the impact of elevated BMI on perioperative sagittal alignment parameters in patients undergoing single-level lumbar fusion.
Main Methods:
- Retrospective cohort study of 832 adult patients undergoing single-level lumbar fusion (2010-2019).
- Collected spinopelvic parameters (lumbar lordosis, segmental lordosis, disc height, sacral slope, pelvic tilt, pelvic incidence) from lateral lumbar radiographs.
- Classified patients by BMI (normal, overweight, obese) and dichotomized based on spinopelvic instability criteria (pelvic tilt >20°, pelvic incidence-lumbar lordosis mismatch >10°).
Main Results:
- Increasing BMI correlated with a higher incidence of male sex, increased comorbidity burden (Elixhauser Comorbidity Index), and worse preoperative sagittal balance (higher pelvic tilt).
- Patients with higher BMI were more likely to have preoperative pelvic tilt >20°.
- Logistic regression identified BMI (OR: 1.06) and preoperative pelvic incidence-lumbar lordosis mismatch (OR: 1.17) as independent predictors of postoperative pelvic incidence-lumbar lordosis mismatch >10° at 2-3 years.
Conclusions:
- Elevated BMI is associated with poorer preoperative sagittal alignment and increased comorbidity burden in patients undergoing lumbar fusion.
- Increasing BMI independently predicts the failure to achieve ideal long-term postoperative spinopelvic alignment (pelvic incidence-lumbar lordosis mismatch).
