Garcia Rafael, Odland Kari, Sembrano Jonathan
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Int J Spine Surg. 2025 Sep 2;19(4):375-382. doi: 10.14444/8752.
Obesity is often associated with worse outcomes after lumbar fusion surgery, but its impact on patient-reported outcomes in spondylolisthesis remains unclear. This study assesses the effect of body mass index (BMI) on outcomes for degenerative and isthmic spondylolisthesis patients undergoing lumbar fusion.
We conducted a retrospective analysis of 86 patients with low-grade lumbar degenerative and isthmic spondylolisthesis, categorized by BMI into nonobese (<30 kg/m²), obesity class I (30.0-34.9 kg/m²), obesity class II (35.0-39.9 kg/m²), and obesity class III (≥40.0 kg/m²). Outcomes were measured using the visual analog scale (VAS) for pain and the Oswestry Disability Index (ODI) at baseline and 12 months postoperatively. Statistical analyses included a 1-way analysis of variance, Bonferroni post hoc comparisons, and Kruskal-Wallis tests.
Significant disability improvements (mean ODI improvement: 15.6 points, < 0.001) were observed across all BMI categories, while pain improvements were less pronounced (mean VAS improvement: 2.1 points, < 0.001). Nonobese and class II patients maintained improvements at 12 months. Degenerative spondylolisthesis patients showed better ODI outcomes compared with isthmic patients ( = 0.019), while VAS outcomes were similar ( = 0.251).
Lumbar fusion results in significant disability reduction across BMI categories, with sustained improvements in nonobese and obesity class II patients. These findings suggest that obesity should not be a contraindication for lumbar fusion in well-selected patients, as meaningful improvements can be achieved, particularly in disability outcomes.
Clinically, this supports a more individualized approach to surgical candidacy, emphasizing functional goals and symptom burden over BMI alone, thereby promoting equitable access to care and helping guide preoperative counseling and shared decision-making.
肥胖常与腰椎融合术后较差的预后相关，但肥胖对腰椎滑脱患者报告结局的影响尚不清楚。本研究评估体重指数（BMI）对接受腰椎融合术的退行性和峡部裂性腰椎滑脱患者结局的影响。
我们对86例低度腰椎退行性和峡部裂性腰椎滑脱患者进行了回顾性分析，根据BMI分为非肥胖（<30 kg/m²）、I类肥胖（30.0 - 34.9 kg/m²）、II类肥胖（35.0 - 39.9 kg/m²）和III类肥胖（≥40.0 kg/m²）。在基线和术后12个月使用视觉模拟量表（VAS）评估疼痛，并使用Oswestry功能障碍指数（ODI）评估结局。统计分析包括单因素方差分析、Bonferroni事后比较和Kruskal - Wallis检验。
所有BMI类别均观察到显著的功能障碍改善（平均ODI改善：15.6分，<0.001），而疼痛改善不太明显（平均VAS改善：2.1分，<0.001）。非肥胖和II类患者在12个月时维持改善。与峡部裂性患者相比，退行性腰椎滑脱患者的ODI结局更好（=0.019），而VAS结局相似（=0.251）。
腰椎融合术可使各BMI类别的功能障碍显著减轻，非肥胖和II类肥胖患者有持续改善。这些发现表明，对于精心挑选的患者，肥胖不应成为腰椎融合术的禁忌证，因为可以实现有意义的改善，特别是在功能障碍结局方面。
临床上，这支持采用更个体化的手术候选评估方法，强调功能目标和症状负担，而非仅关注BMI，从而促进公平的医疗服务获取，并有助于指导术前咨询和共同决策。
