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

Obesity is highly prevalent among individuals with spinal cord injury (SCI), primarily due to neurogenic alterations in metabolism and body composition. Despite the established efficacy of metabolic surgery (MS) in the general population, its application in SCI patients remains extremely limited, with scarce data on eligibility, feasibility, and safety.

This study aims to evaluate the eligibility, perioperative outcomes, and short-term efficacy of a structured metabolic surgery program for patients with SCI and neurogenic obesity.

This retrospective cohort study utilized prospectively collected data from 530 patients with SCI followed at a national neurorehabilitation center (2022-2025). A multidisciplinary assessment identified suitable candidates for MS. Clinical, functional, and surgical variables were recorded, and postoperative outcomes were analyzed at 6 months.

Among 201 patients with obesity (BMI >30 kg/m²), 76 underwent full evaluation, and only 12 (6%) proceeded to surgery. Primary exclusion reasons included psychiatric disorders (22%), eating disorders (23%), and patient refusal (8%). Surgical techniques employed were sleeve gastrectomy (n=7) and Roux-en-Y gastric bypass (n = 5), with no intraoperative complications. Postoperative complications occurred in 4 patients (33%), including one Clavien IVa. At 6 months, %TWL reached 26.5%, with significant fat mass reduction and preserved skeletal muscle when adjusted for body weight. Functional capacity improved or was maintained.

Metabolic surgery is a feasible and safe option in a highly selected subgroup of patients with SCI. However, complex biopsychosocial barriers limit its widespread applicability. Specialized centers with multidisciplinary teams are essential to optimize outcomes and minimize complications in this vulnerable population.