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Published on: July 15, 2021
Associations of BMI-Waist Circumference Phenotypes With Sagittal Alignment and 6-Month Residual Low Back Pain After
Meng Li1, Jianhua Ren2, Junkai Kou2
1Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China; Department of Orthopedics, Lingshou County Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, 050500, China.
Background:
Body mass index (BMI) does not fully capture fat distribution. We evaluated associations of BMI-waist circumference phenotypes with perioperative outcomes, preoperative sagittal alignment, and postoperative recovery after single-level L4-5 PLIF/TLIF.
Methods:
This retrospective cohort study included 315 patients undergoing conventional open L4-5 PLIF/TLIF between June 2022 and June 2024. Patients were classified as having normal BMI without central obesity (Group A, n = 105), normal-BMI central obesity (Group B, n = 55), or high-BMI central obesity (Group C, n = 155). Perioperative variables, preoperative sagittal parameters, pain, disability, and residual low back pain at 6 months (VAS-back ≥3) were compared among groups. BMI, WC, and abdominal circumference were evaluated in separate adjusted models.
Results:
Perioperative outcomes and several preoperative sagittal parameters differed among the phenotypes. Groups B and C generally had higher pain and disability scores than Group A at 3 and 6 months, and residual low back pain occurred in 11%, 24%, and 28% of Groups A, B, and C, respectively (P = 0.005). No significant between-group differences in pain or disability remained at 12 months. In separate adjusted models, BMI, WC, and abdominal circumference were associated with several sagittal parameters and 6-month clinical outcomes.
Conclusions:
BMI-WC phenotypes were associated with perioperative outcomes, preoperative sagittal alignment, and early-to-intermediate postoperative outcomes. The observed pattern was more consistent with slower early recovery than with persistent 12-month impairment. WC and abdominal circumference may complement BMI in anthropometric assessment, but their incremental prognostic value requires further investigation.
