The obesity epidemic makes life difficult for patients with herniated lumbar discs – and for back-surgeons: Increased risk of complications

Abstract

[ In this issue of the Scandinavian Journal of Pain, Jarvimaki et al. ocus on problems and complications arising in pre-obese and bese patients who need back surgery, discectomy in particular 1]. The epidemic of obesity has reached the Nordic countries, and or persons above 60 years of age, Western Europe has prevalence bout 20% for men and about 30% for women [2]. Excess bodyweight is among the highest risk factors for ncreased burden of disease globally, contributing to development f ischaemic heart disease, hypertension, osteoarthritis, diabetes ellitus, and stroke, cancer of the colon, breast and endometrium 2]. In their survey of lumbar discectomy patients, Jarvimaki et al. ound that outcomes of surgery with respect to functional disabilty, depressed mood, and social activities were worse among those ith BMI in the obese category (BMI >30 kg/m2) [1]. Both the prebese (BMI >25 and <30) and the obese patients gained weight uring the postoperative follow-up time of about 2 years. It is almost self-evident that technical difficulties for the sureon doing minimally invasive discectomies will be more severe hen operating on an obese patient compare with a non-obese atient. This may be the reason for a higher prevalence of reoperaions among their obese patients [1]. Postoperative complications nd cost significantly increase compared with none-obese patients 3]. Similarly, the anaesthesia team will have more challenges aneshetizing an obese patient; turning an obese patient under full eneral anaesthesia to the prone position is also not a trivial underaking. The increased costs are due to longer operating time, longer naesthesia time, more often admission to the intensive care unit s well as longer hospital stay [3]. We therefore agree hole-heartily with Jarvimaki et al. [1] that bese patients with prolapsed lumbar disc must be helped lose