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Spinal problems

Bariatric surgery helps back pain and life quality

(Image courtesy of FreeDigitalPhotos.net and Renjith Krishnan)
BMI is an independent predictor of improvement in leg pain

Bariatric surgery results in a significant reduction of back pain and improves the quality of life for patients, claims a study published in the journal Spine.

The researchers from Tel Aviv Sourasky Medical Center, Belinson Medical Center and the Hadassah Hebrew University Medical Center, Israel, reported that bariatric surgery was associated with a significant increase in the height space between discs, as well as a significant clinical improvement in axial back and radicular leg pain.

Designed to determine the effect of weight loss on quality of life and back pain in severely obese patients undergoing bariatric surgery, the study also looked at the correlation between these effects with changes in disc space height.

Thirty-five morbidly obese adults (15 female) undergoing bariatric surgery were enrolled in the study and patients received laparoscopic gastric banding, sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass or a duodenal switch, according to the individual characteristics of the patient.

The patients' height and weight were measured before and a year after surgery, and abdominal computed tomographic scans were obtained at the L4–L5 vertebral body levels at the same time.

Quality of life was also assessed before and one year post-surgery, using the 36-Item Short Form Health Survey (SF-36) and Moorehead-Ardelt (MA) questionnaires. Pain assessment was quantified using the visual analogue scale score.

Prior to surgery, 26 patients experienced axial back pain, 16 patients had radicular leg pain, 15 patients described a combination of both axial and radicular pain, and four patients had no axial or radicular pain.

Results

All 30 patients completed the study and the average body weight decreased from 119.6 ± 20.7kg (BMI 42.8 ± 4.8 to 82.9 ± 14.0kg (BMI 29.7 ± 3.4) p<0.001).

Both axial and radicular back pain decreased after surgery (p<0.001) with patients reporting (Moorehead-Ardelt score) significant changes (p<0.001).

There was also a significant radiographical increase in the L4–L5 disc space height, from 6±1.3mm pre-surgery to 8±1.5mm post-surgery (p< 0.001).

The SF-36 score did not show any statistically significant improvement after surgery, although the physical component of the questionnaire showed a positive trend for improvement.

The authors noted that there was no correlation between the amount of weight reduction and the increment in disc space height or back pain improvement. However, they stated that a reduction in BMI was an independent predictor of improvement in leg pain.

“Our findings indicate that reduction in body weight after bariatric surgery is associated with a significant radiographical increase in the L4–L5 disc space height, as well as a significant clinical improvement in axial back and radicular leg pain,” they conclude. “The disc space height restoration and back pain behave in a nonlinear fashion; this phenomenon may be explained by the severe load posed on the lumbar spine of overweight patients, leading to marked degenerative changes and loss of elasticity.”

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