Kuyl Emile-Victor, Gupta Arnav, Parel Philip M, Quan Theodore, Patel Tushar Ch, Mesfin Addisu
Department of Orthopaedic Surgery, School of Medicine and Health Sciences, George Washington University, Washington.
Washington Orthopaedics and Sports Medicine, Washington, DC.
Clin Spine Surg. 2025 Mar 1;38(2):E115-E121. doi: 10.1097/BSD.0000000000001669. Epub 2024 Aug 12.
Retrospective cohort study.
This study aimed to assess whether prior bariatric surgery (BS) is associated with higher 10-year surgical complication and revision rates in lumbar spine fusion compared with the general population and morbidly obese patients.
Obesity accelerates degenerative spine processes, often necessitating lumbar fusion for functional improvement. BS is explored for weight loss in lumbar spine cases, but its impact on fusion outcomes remains unclear. Existing literature on BS before lumbar fusion yields conflicting results, with a limited investigation into long-term spine complications.
Utilizing the PearlDiver database, we examined patients undergoing elective primary single-level lumbar fusion, categorizing them by prior BS. Propensity score matching created cohorts from (1) the general population without BS history and (2) morbidly obese patients without BS history. Using Kaplan-Meier and Cox proportional hazard modeling, we compared 10-year cumulative incidence rates and hazard ratios (HRs) for all-cause revision and specific revision indications.
Patients who underwent BS exhibited a higher cumulative incidence and risk of decompressive laminectomy and irrigation & debridement (I&D) within 10 years postlumbar fusion compared with matched controls from the general population [decompressive laminectomy: HR = 1.32; I&D: HR = 1.35]. Compared with matched controls from a morbidly obese population, patients who underwent BS were associated with lower rates of adjacent segment disease (HR = 0.31) and I&D (HR = 0.64). However, the risk of all-cause revision within 10 years did not increase for patients who underwent BS compared with matched or unmatched controls from the general population or morbidly obese patients ( P > 0.05).
Prior BS did not elevate the 10-year all-cause revision risk in lumbar fusion compared with the general population or morbidly obese patients. However, patients who underwent BS were associated with a lower 10-year risk of I&D when compared with morbidly obese patients without BS. Our study indicates comparable long-term surgical complication rates between patients who underwent BS and these control groups, with an associated reduction in risk of infectious complications when compared with morbidly obese patients. Although BS may address medical comorbidities, its impact on long-term lumbar fusion revision outcomes is limited.
回顾性队列研究。
本研究旨在评估与普通人群及病态肥胖患者相比，既往减肥手术（BS）是否与腰椎融合手术中更高的10年手术并发症及翻修率相关。
肥胖会加速脊柱退变进程，常需进行腰椎融合术以改善功能。在腰椎疾病病例中探索BS用于减重，但其对融合结果的影响仍不明确。关于腰椎融合术前BS的现有文献结果相互矛盾，对长期脊柱并发症的研究有限。
利用PearlDiver数据库，我们检查了接受择期原发性单节段腰椎融合术的患者，并根据既往是否接受BS进行分类。倾向评分匹配从（1）无BS病史的普通人群和（2）无BS病史的病态肥胖患者中创建队列。使用Kaplan-Meier和Cox比例风险模型，我们比较了全因翻修和特定翻修指征的10年累积发病率和风险比（HRs）。
与来自普通人群的匹配对照组相比，接受BS的患者在腰椎融合术后10年内减压性椎板切除术和冲洗清创术（I&D）的累积发病率和风险更高[减压性椎板切除术：HR = 1.32；I&D：HR = 1.35]。与来自病态肥胖人群的匹配对照组相比，接受BS的患者相邻节段疾病发生率（HR = 0.31）和I&D发生率（HR = 0.64）较低。然而，与来自普通人群或病态肥胖患者的匹配或不匹配对照组相比，接受BS的患者在10年内全因翻修风险并未增加（P>0.05）。
与普通人群或病态肥胖患者相比，既往BS并未增加腰椎融合术10年全因翻修风险。然而，与未接受BS的病态肥胖患者相比，接受BS的患者10年I&D风险较低。我们的研究表明，接受BS的患者与这些对照组的长期手术并发症发生率相当，与病态肥胖患者相比，感染并发症风险有所降低。虽然BS可能解决合并症问题，但其对长期腰椎融合翻修结果的影响有限。
