Extra Weight and Slipped Discs

Obesity may lead to poorer lumbar disc herniation treatment results

February 1, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Carrying excess weight can aggravate your lower back and cause other musculoskeletal problems. But when it comes to slipped discs in the spine, not much is known about the effect of that excess weight.

A recent study looked at the effects of obesity on lumbar disc herniation treatment. Obese patients didn't fare as well as non-obese patients when it came to improvement of low back pain and sciatica (pain along the nerve that runs from the lower back through each leg).

On the other hand, obese patients were not any less satisfied with treatment and did not have a higher rate of repeat disc herniation or surgery.

"Discuss a treatment plan for obesity with your doctor."

Jeffrey Rihn, MD, of the Thomas Jefferson University Hospital, and colleagues studied 854 non-obese patients and 336 obese patients. All 1,190 study participants underwent either surgical or nonsurgical treatment for lumbar disc herniation.

Lumbar disc herniation is commonly referred to as a slipped or ruptured disc in the spine. Minor herniations usually heal within several weeks but severe herniations may require surgery.

Non-surgical treatments for lumbar disc herniation can include anti-inflammatory and pain relief treatments like aspirin, cortisone and steroid injections. Physical therapy and graduated exercise are also often recommended.

The study participants were from 11 different states across the US and were enrolled in the Spine Research Outcomes Trial (SPORT) database. Patients enrolled in SPORT are followed for up to four years to understand outcomes of back and leg pain.

Collected SPORT records included patient demographics and details of their medical conditions throughout follow-ups. Dr. Rihn and team studied rates of disability, pain and physical function within the patient data.

The study showed that obese patients had less improvement when it came to being bothered by sciatica and low back pain. There was also less improvement when it came to disability and function among the obese patients than the non-obese patients.

No difference between the two patient groups was seen when it came to rates of infection, complications during surgery, recurrent disc herniation or need for reoperation. There was also no significant difference in overall treatment satisfaction.

Obesity can present problems in medical treatment. The condition can complicate surgical treatments by increasing surgery time, blood loss and length of hospital stays.

Carol Wolin-Riklin, MA, RD, LD, is a registered dietician and an instructor at the UTHealth Medical School Department of Surgery. Wolin-Riklin suggests that those who are overweight begin a global treatment plan rather than one focused on a single medical issue.

“Using interventions that help bring positive changes in lifestyle, diet and exercise in conjunction with surgical or nonsurgical treatment for lumbar disc herniation may just be the best treatment plan to assist in improving outcomes in obese patients,” said Wolin-Riklin.

She also pointed out that body mass index, the measure used in this study to define obesity, is not always the best tool. “Age and muscle mass may impact an individual’s BMI so that the BMI may not accurately reflect true obesity,” added Wolin-Riklin.

Dr. Rihn believes these study results are important for the treatment of patients with lumbar disc herniation. Patient’s can better understand what level of satisfaction and recovery to expect from their course of treatment.

The study was published in the Journal of Bone and Joint Surgery.

Funding was provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Office of Research on Women’s Health, the National Institutes of Health, the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention.

The study authors reported associations with a third party directly or indirectly in support of an aspect of the study and a biomedical entity.