Less benefit for obese with lumbar disc herniation tx

In an effort to examine the impact of obesity on the outcomes of treatments for lumbar disc herniation, Jeffrey A. Rihn, M.D., from the Thomas Jefferson University Hospital in Philadelphia, and colleagues compared 854 non-obese patients with a body mass index of <30 kg/m² with 336 obese patients with a body mass index of ≥30 kg/m² participating in the Spine Patient Outcomes Research Trial.

The researchers found that, at the end of the four-year follow-up assessment, in both the operative treatment group and non-operative treatment group, compared with non-obese patients, the improvement in obese patients was significantly less, as measured by the Short-Form 36 (SF-36) physical function, SF-36 bodily pain, and Oswestry Disability Index. The exception to this was seen in the SF-36 bodily pain score, which was statistically similar for obese and non-obese patients in the non-operative treatment group (P = 0.39). At follow-up there was significantly less improvement in the Sciatica Bothersomeness Index and the Low Back Pain Bothersomeness Index among obese versus non-obese patients who had been managed operatively. There was no significant difference in patient satisfaction or self-rated improvement between obese and non-obese patients. Body mass index did not affect the benefit of surgery over non-operative treatment.

"Obese patients realized less clinical benefit from both operative and non-operative treatment of lumbar disc herniation," write the authors. "Surgery provided similar benefit over non-operative treatment in obese and non-obese patients."

Several authors disclosed financial ties to an entity in the biomedical arena.

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