Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation

Fatima N Anwar; Andrea M Roca; Alexandra C Loya; Srinath S Medakkar; Timothy J Hartman; James W Nie; Keith R MacGregor; Omolabake O Oyetayo; Eileen Zheng; Vincent P Federico; Dustin H Massel; Arash J Sayari; Gregory D Lopez; Kern Singh

doi:10.1097/BSD.0000000000001562

Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation

Clin Spine Surg. 2024 Jan 8. doi: 10.1097/BSD.0000000000001562. Online ahead of print.

Authors

Fatima N Anwar¹, Andrea M Roca, Alexandra C Loya, Srinath S Medakkar, Timothy J Hartman, James W Nie, Keith R MacGregor, Omolabake O Oyetayo, Eileen Zheng, Vincent P Federico, Dustin H Massel, Arash J Sayari, Gregory D Lopez, Kern Singh

Affiliation

¹ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.

PMID: 38245814
DOI: 10.1097/BSD.0000000000001562

Abstract

Study design: Retrospective review.

Objective: To assess the impact of Body Mass Index (BMI) on patient-reported outcome measures (PROMs) after cervical disc replacement (CDR).

Background: BMI may affect PROMs after spine surgery.

Methods: Primary CDR recipients for herniated disc(s) with BMI <40 were retrospectively selected from a single-surgeon registry. Cohorts were divided into non-obese (BMI <30) and obese (BMI ≥30). Intercohort in-hospital complication rates were compared through independent samples t tests. Pre/postoperative PROMs were compared between cohorts through multivariable regression accounting for demographic differences. Final follow-up dates between patients averaged 11.8 ± 9.3 months. PROMs assessed included Patient-reported Outcomes Measurement Information System-Physical Function, Neck Disability Index, Visual Analog Scale-Neck, Visual Analog Scale-Arm, and the 9-item Patient Health Questionnaire. Improvements in PROMs were evaluated and compared at each follow-up within cohorts through paired t tests. The magnitude of improvement in PROMs from preoperative baseline at 6-week follow-up (∆PROM-6W) and final follow-up (∆PROM-FF) along with achievement rates of minimum clinically important differences were compared between cohorts through multivariable regression accounting for demographic differences.

Results: Of 153 patients, 53 patients were noted as obese. Demographic differences included age, prevalence of hypertension and diabetes, and comorbidity burden scores (P ≤ 0.011, all). No significant variations in in-hospital complications were found. The non-obese cohort demonstrated improvements in all PROMs at 6 weeks and final follow-up periods (P ≤ 0.005, all). The obese cohort demonstrated improvements in all postoperative PROMs besides 9-item Patient Health Questionnaire at 6 weeks (P ≤ 0.015, all). After accounting for age and comorbidity variations, there were no significant intercohort differences in raw PROM scores, ∆PROM-6W, ∆PROM-FF, or minimum clinically important difference achievement rates.

Conclusions: Regardless of BMI, patients experience significant improvements in physical function, disability, pain, and mental health after CDR for disc herniation. Patients with obesity do not suffer inferior patient-perceived outcomes after CDR. These findings may help surgeons counsel patients in the preoperative period.