Relationship between body mass index and sagittal vertical axis change as well as health-related quality of life in 564 patients after deformity surgery

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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OBJECTIVE

Obesity, a condition that is increasing in prevalence in the United States, has previously been associated with poorer outcomes following deformity surgery, including higher rates of perioperative complications such as deep and superficial infections. To date, however, no study has examined the relationship between preoperative BMI and outcomes of deformity surgery as measured by spine parameters such as the sagittal vertical axis (SVA), as well as health-related quality of life (HRQoL) measures such as the Oswestry Disability Index (ODI) and Scoliosis Research Society–22 patient questionnaire (SRS-22). To this end, the authors sought to clarify the relationship between BMI and postoperative change in SVA as well as HRQoL outcomes.

METHODS

The authors performed a retrospective review of a prospectively managed multicenter adult spinal deformity database collected and maintained by the International Spine Study Group (ISSG) between 2009 and 2014. The primary independent variable considered was preoperative BMI. The primary outcome was the change in SVA at 1 year after deformity surgery. Postoperative ODI and SRS-22 outcome measures were evaluated as secondary outcomes. Generalized linear models were used to model the primary and secondary outcomes at 1 year as a function of BMI at baseline, while adjusting for potential measured confounders.

RESULTS

Increasing BMI (compared to BMI < 18) was not associated with change of SVA at 1 year postsurgery. However, BMIs in the obese range of 30 to 34.9 kg/m2, compared to BMI < 18 at baseline, were associated with poorer outcomes as measured by the SRS-22 score (estimated change −0.47, 95% CI −0.93 to −0.01, p = 0.04). While BMIs > 30 appeared to be associated with poorer outcomes as determined by the ODI, this correlation did not reach statistical significance.

CONCLUSIONS

Baseline BMI did not affect the achievable SVA at 1 year postsurgery. Further studies should evaluate whether even in the absence of a change in SVA, baseline BMIs in the obese range are associated with worsened HRQoL outcomes after spinal surgery.

ABBREVIATIONS HRQoL = health-related quality of life; ISSG = International Spine Study Group; LL = lumbar lordosis; ODI = Oswestry Disability Index; PJK = proximal junctional kyphosis; PT = pelvic tilt; SRS-22 = Scoliosis Research Society–22 patient questionnaire; SSI = surgical site infection; SVA = sagittal vertical axis.
Article Information

Contributor Notes

Correspondence D. Kojo Hamilton: University of Pittsburgh Medical Center, Pittsburgh, PA. hamiltondk@upmc.edu.INCLUDE WHEN CITING Published online August 9, 2019; DOI: 10.3171/2019.4.SPINE18485.Disclosures Dr. Okonkwo reports being a consultant for NuVasive, Zimmer Biomet, and Stryker. Dr. Passias reports being a consultant for Spinewave, Zimmer Biomet, and Medicrea and being a scientific advisory board member for AlloSource. Dr. V. Lafage reports direct stock ownership in Nemaris Inc.; receiving support of non–study-related clinical or research effort overseen by author from DePuy Spine, NuVasive, K2M, and Stryker (grants paid through ISSGF); and being a consultant (receiving payment for lectures) for DePuy Spine, AOSpine, and K2M. Dr. Schwab reports direct stock ownership in Nemaris Inc.; being a consultant for Zimmer Biomet, K2M, NuVasive, Medicrea, and Medtronic; receiving support of non–study-related clinical or research effort overseen by author from DePuy Spine, K2M, Stryker, and NuVasive (grants paid through ISSGF); and speaking/teaching arrangements with Zimmer Biomet, K2M, NuVasive, and Medtronic. Dr. Bess reports being a consultant for EOS, K2 Medical, Misonix, and AlloSource; being a patent holder for K2 Medical; receiving clinical or research support for the study described (includes equipment or material) from the ISSGF; and receiving support of non–study-related clinical or research effort overseen by author from the ISSGF. Dr. Ames reports being an employee of UCSF; being a consultant for DePuy Synthes, Medtronic, Stryker, Medicrea, K2M, and Zimmer Biomet; receiving royalties from Stryker, Zimmer Biomet, DePuy Synthes, NuVasive, Next Orthosurgical, and K2M; ownership and receiving royalties from Medicrea; ownership and conducting research for Titan Spine, DePuy Synthes, and ISSG; ownership and being on the editorial board of Operative Neurosurgery; ownership and receiving grant funding from SRS; ownership and being on the executive committee for ISSG; and ownership and being the director of Global Spinal Analytics. Dr. Smith reports being a consultant for NuVasive, Zimmer Biomet, K2M/Stryker, AlloSource, and Cerapedics; receiving clinical or research support for the study described (includes equipment or material) from DePuy Synthes/ISSG; receiving support of non–study-related clinical or research effort overseen by author from DePuy Synthes/ISSG and AOSpine; receiving royalties from Zimmer Biomet and NuVasive; and receiving fellowship funding from NREF and AOSpine. Dr. Shaffrey reports being a consultant for Medtronic, NuVasive, and EOS; direct stock ownership in NuVasive; and being a patent holder for Medtronic, NuVasive, and Zimmer Biomet. Dr. Burton reports being a consultant for DePuy and AlloSource; being a patent holder for DePuy; and receiving clinical or research support for the study described (includes equipment or material) from DePuy and Pfizer.
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References
  • 1

    Blondel BSchwab FUngar BSmith JBridwell KGlassman S: Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 71:3413482012

    • Search Google Scholar
    • Export Citation
  • 2

    Bourghli AAunoble SReebye OLe Huec JC: Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J 20 (Suppl 5):6636682011

    • Search Google Scholar
    • Export Citation
  • 3

    Drazin DShirzadi ARosner JEboli PSafee MBaron EM: Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 31(4):E32011

    • Search Google Scholar
    • Export Citation
  • 4

    Fairbank JC: Oswestry Disability Index. J Neurosurg Spine 20:2392412014 (Letter)

  • 5

    General Assembly of the World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent 81:14182014

    • Search Google Scholar
    • Export Citation
  • 6

    Glassman SDBerven SBridwell KHorton WDimar JR: Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:6826882005

    • Search Google Scholar
    • Export Citation
  • 7

    Glassman SDBridwell KDimar JRHorton WBerven SSchwab F: The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:202420292005

    • Search Google Scholar
    • Export Citation
  • 8

    Goldschmidt EAngriman FAgarwal NTrevisan MZhou JChen K: A new piece of the puzzle to understand cervical sagittal alignment: utilizing a novel angle δ to describe the relationship among T1 vertebral body slope, cervical lordosis, and cervical sagittal alignment. Neurosurgery [epub ahead of print] 2019

    • Search Google Scholar
    • Export Citation
  • 9

    Goldschmidt EAngriman FFerreyro BAgarwal NZhou JChen K: Design and testing of 2 novel scores that predict global sagittal alignment utilizing cervical or lumbar plain radiographs. Neurosurgery 82:1631712018

    • Search Google Scholar
    • Export Citation
  • 10

    Kim YJBridwell KHLenke LGCheh GBaldus C: Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 32:218921972007

    • Search Google Scholar
    • Export Citation
  • 11

    Lafage VSchwab FVira SPatel AUngar BFarcy JP: Spino-pelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine (Phila Pa 1976) 36:103710452011

    • Search Google Scholar
    • Export Citation
  • 12

    Lau DFunao HClark AJNicholls FSmith JBess S: The clinical correlation of the Hart-ISSG Proximal Junctional Kyphosis Severity Scale with health-related quality-of-life outcomes and need for revision surgery. Spine (Phila Pa 1976) 41:2132232016

    • Search Google Scholar
    • Export Citation
  • 13

    Malta MCardoso LOBastos FIMagnanini MMSilva CM: STROBE initiative: guidelines on reporting observational studies. Rev Saude Publica 44:5595652010

    • Search Google Scholar
    • Export Citation
  • 14

    Merola AAHaher TRBrkaric MPanagopoulos GMathur SKohani O: A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine (Phila Pa 1976) 27:204620512002

    • Search Google Scholar
    • Export Citation
  • 15

    Ogden CLCarroll MDKit BKFlegal KM: Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311:8068142014

    • Search Google Scholar
    • Export Citation
  • 16

    Patel NBagan BVadera SMaltenfort MGDeutsch HVaccaro AR: Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 6:2912972007

    • Search Google Scholar
    • Export Citation
  • 17

    Pull ter Gunne AFvan Laarhoven CJCohen DB: Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 19:9829882010

    • Search Google Scholar
    • Export Citation
  • 18

    Salvetti DJTempel ZJGoldschmidt EColwell NAAngriman FPanczykowski DM: Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series. J Neurosurg 29:5495522018

    • Search Google Scholar
    • Export Citation
  • 19

    Schwab FFarcy JPBridwell KBerven SGlassman SHarrast J: A clinical impact classification of scoliosis in the adult. Spine (Phila Pa 1976) 31:210921142006

    • Search Google Scholar
    • Export Citation
  • 20

    Smith JSShaffrey CIGlassman SDCarreon LYSchwab FJLafage V: Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 22:4024102013

    • Search Google Scholar
    • Export Citation
  • 21

    Soroceanu ABurton DCDiebo BGSmith JSHostin RShaffrey CI: Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. J Neurosurg Spine 23:6566642015

    • Search Google Scholar
    • Export Citation
  • 22

    Watanabe KLenke LGBridwell KHKim YJKoester LHensley M: Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs: analysis of morphological features. Spine (Phila Pa 1976) 35:1381452010

    • Search Google Scholar
    • Export Citation
  • 23

    Youssef JAOrndorff DOPatty CAScott MAPrice HLHamlin LF: Current status of adult spinal deformity. Global Spine J 3:51622013

    • Search Google Scholar
    • Export Citation
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