Metabolic Surgery Program for Patients with Spinal Cord Injury: Eligibility, Feasibility, and Safety

Area of Science:

• Neuroscience
• Bariatric Surgery
• Rehabilitation Medicine

Background:

• Obesity is prevalent in spinal cord injury (SCI) due to metabolic and body composition changes.
• Metabolic surgery (MS) efficacy is known in the general population, but its use in SCI patients is limited.
• Data on eligibility, feasibility, and safety of MS for SCI patients is scarce.

Purpose of the Study:

• Evaluate eligibility for a structured metabolic surgery program in SCI patients with neurogenic obesity.
• Assess perioperative outcomes and short-term efficacy of MS in this population.
• Determine the safety and feasibility of metabolic surgery for individuals with spinal cord injury.

Main Methods:

• Retrospective cohort study using prospectively collected data from 530 SCI patients (2022-2025).
• Multidisciplinary assessment identified suitable candidates for metabolic surgery.
• Postoperative outcomes analyzed at 6 months, including % Total Weight Loss (%TWL) and body composition.

Main Results:

• Only 12% of evaluated SCI patients (n=12) proceeded to MS due to psychiatric/eating disorders and refusal.
• Sleeve gastrectomy and Roux-en-Y gastric bypass were performed with no intraoperative complications.
• At 6 months, %TWL was 26.5%, with fat mass reduction and preserved skeletal muscle; functional capacity was maintained or improved.

Conclusions:

• Metabolic surgery is feasible and safe for a highly selected subgroup of SCI patients.
• Biopsychosocial barriers significantly limit the widespread applicability of MS in SCI.
• Specialized multidisciplinary centers are crucial for optimizing outcomes and minimizing complications in this vulnerable population.