Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery

Paul Khoueir, Mary Helen Black, Peter F. Crookes, Howard S. Kaufman, Namir Katkhouda, Michael Y. Wang

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: The prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven. Purpose: This study prospectively assessed clinically reported changes in chronic axial low back pain symptoms after weight reduction from bariatric surgery for morbid obesity. Study design: Prospective longitudinal study. Patient sample: Fifty-eight consecutive patients with morbid obesity and chronic axial low back pain undergoing bariatric surgery over a period of 6 months. Patients were considered morbidly obese if they were 50% to 100% above their ideal body weight or having a body mass index (BMI) greater than 40. Outcome measures: Visual Analog Scale (VAS) for axial low back pain, Short Form-36 (SF-36) Health Survey, and Oswestry Disability Index (ODI). Methods: Patients undergoing weight reduction surgery were assessed preoperatively and postoperatively at 12 months with validated clinical measures for axial back pain and disability (VAS, SF-36, and ODI). Bariatric surgery parameters included demographic data, weight, and BMI. Statistical analysis included paired t tests and multiple regression techniques. Results: Of the initial 58 patients, 38 (65%) completed both preoperative (Pre-Op) and postoperative (Post-Op) questionnaires at 12 months. These 38 subjects included 30 women and 8 men, with an age range of 20 to 68 years (mean 48.4±10.1). Overall, these patients showed a decrease in mean weight from 144.52±41.21 kg Pre-Op to 105.59±29.24 Post-Op (p<.0001) and BMI from 52.25±12.61 kg/m2 Pre-Op to 38.32±9.66 Post-Op (p<.0001). Patients demonstrated a statistically significant mean 44% decrease in axial back pain on the VAS scale (p=.006; 5.2±3.35 Pre-Op, to 2.9±3.1 Post-Op). Analysis of the SF-36 major components revealed that patients experienced significant increases in mean physical health by 58% (p<.0001; 44.5±20.09 to 70.24±26.84) and in median mental health by 6% (p=.03; 70±7.14 to 73.39±11.78). Patients also showed statistically significant 24% decrease in Post-Op ODI score for physical disability (p=.05) from 26.75±16.56 Pre-Op to 20.35±18.71 Post-Op (p=.05). Conclusion: This study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.

Original languageEnglish
Pages (from-to)454-463
Number of pages10
JournalSpine Journal
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2009
Externally publishedYes

Fingerprint

Bariatrics
Back Pain
Weight Loss
Bariatric Surgery
Low Back Pain
Visual Analog Scale
Body Mass Index
Morbid Obesity
Weights and Measures
Ideal Body Weight
Health Surveys
Developed Countries
Longitudinal Studies
Mental Health
Obesity
Demography
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Bariatric surgery
  • Body mass index
  • Chronic back pain
  • Lumbago
  • Obesity
  • Oswestry Disability Index
  • Short Form-36
  • Spine
  • Spondylosis
  • Weight loss

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Khoueir, P., Black, M. H., Crookes, P. F., Kaufman, H. S., Katkhouda, N., & Wang, M. Y. (2009). Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery. Spine Journal, 9(6), 454-463. https://doi.org/10.1016/j.spinee.2009.02.003

Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery. / Khoueir, Paul; Black, Mary Helen; Crookes, Peter F.; Kaufman, Howard S.; Katkhouda, Namir; Wang, Michael Y.

In: Spine Journal, Vol. 9, No. 6, 01.06.2009, p. 454-463.

Research output: Contribution to journalArticle

Khoueir, P, Black, MH, Crookes, PF, Kaufman, HS, Katkhouda, N & Wang, MY 2009, 'Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery', Spine Journal, vol. 9, no. 6, pp. 454-463. https://doi.org/10.1016/j.spinee.2009.02.003
Khoueir, Paul ; Black, Mary Helen ; Crookes, Peter F. ; Kaufman, Howard S. ; Katkhouda, Namir ; Wang, Michael Y. / Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery. In: Spine Journal. 2009 ; Vol. 9, No. 6. pp. 454-463.
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T1 - Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery

AU - Khoueir, Paul

AU - Black, Mary Helen

AU - Crookes, Peter F.

AU - Kaufman, Howard S.

AU - Katkhouda, Namir

AU - Wang, Michael Y.

PY - 2009/6/1

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N2 - Background: The prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven. Purpose: This study prospectively assessed clinically reported changes in chronic axial low back pain symptoms after weight reduction from bariatric surgery for morbid obesity. Study design: Prospective longitudinal study. Patient sample: Fifty-eight consecutive patients with morbid obesity and chronic axial low back pain undergoing bariatric surgery over a period of 6 months. Patients were considered morbidly obese if they were 50% to 100% above their ideal body weight or having a body mass index (BMI) greater than 40. Outcome measures: Visual Analog Scale (VAS) for axial low back pain, Short Form-36 (SF-36) Health Survey, and Oswestry Disability Index (ODI). Methods: Patients undergoing weight reduction surgery were assessed preoperatively and postoperatively at 12 months with validated clinical measures for axial back pain and disability (VAS, SF-36, and ODI). Bariatric surgery parameters included demographic data, weight, and BMI. Statistical analysis included paired t tests and multiple regression techniques. Results: Of the initial 58 patients, 38 (65%) completed both preoperative (Pre-Op) and postoperative (Post-Op) questionnaires at 12 months. These 38 subjects included 30 women and 8 men, with an age range of 20 to 68 years (mean 48.4±10.1). Overall, these patients showed a decrease in mean weight from 144.52±41.21 kg Pre-Op to 105.59±29.24 Post-Op (p<.0001) and BMI from 52.25±12.61 kg/m2 Pre-Op to 38.32±9.66 Post-Op (p<.0001). Patients demonstrated a statistically significant mean 44% decrease in axial back pain on the VAS scale (p=.006; 5.2±3.35 Pre-Op, to 2.9±3.1 Post-Op). Analysis of the SF-36 major components revealed that patients experienced significant increases in mean physical health by 58% (p<.0001; 44.5±20.09 to 70.24±26.84) and in median mental health by 6% (p=.03; 70±7.14 to 73.39±11.78). Patients also showed statistically significant 24% decrease in Post-Op ODI score for physical disability (p=.05) from 26.75±16.56 Pre-Op to 20.35±18.71 Post-Op (p=.05). Conclusion: This study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.

AB - Background: The prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven. Purpose: This study prospectively assessed clinically reported changes in chronic axial low back pain symptoms after weight reduction from bariatric surgery for morbid obesity. Study design: Prospective longitudinal study. Patient sample: Fifty-eight consecutive patients with morbid obesity and chronic axial low back pain undergoing bariatric surgery over a period of 6 months. Patients were considered morbidly obese if they were 50% to 100% above their ideal body weight or having a body mass index (BMI) greater than 40. Outcome measures: Visual Analog Scale (VAS) for axial low back pain, Short Form-36 (SF-36) Health Survey, and Oswestry Disability Index (ODI). Methods: Patients undergoing weight reduction surgery were assessed preoperatively and postoperatively at 12 months with validated clinical measures for axial back pain and disability (VAS, SF-36, and ODI). Bariatric surgery parameters included demographic data, weight, and BMI. Statistical analysis included paired t tests and multiple regression techniques. Results: Of the initial 58 patients, 38 (65%) completed both preoperative (Pre-Op) and postoperative (Post-Op) questionnaires at 12 months. These 38 subjects included 30 women and 8 men, with an age range of 20 to 68 years (mean 48.4±10.1). Overall, these patients showed a decrease in mean weight from 144.52±41.21 kg Pre-Op to 105.59±29.24 Post-Op (p<.0001) and BMI from 52.25±12.61 kg/m2 Pre-Op to 38.32±9.66 Post-Op (p<.0001). Patients demonstrated a statistically significant mean 44% decrease in axial back pain on the VAS scale (p=.006; 5.2±3.35 Pre-Op, to 2.9±3.1 Post-Op). Analysis of the SF-36 major components revealed that patients experienced significant increases in mean physical health by 58% (p<.0001; 44.5±20.09 to 70.24±26.84) and in median mental health by 6% (p=.03; 70±7.14 to 73.39±11.78). Patients also showed statistically significant 24% decrease in Post-Op ODI score for physical disability (p=.05) from 26.75±16.56 Pre-Op to 20.35±18.71 Post-Op (p=.05). Conclusion: This study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.

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KW - Body mass index

KW - Chronic back pain

KW - Lumbago

KW - Obesity

KW - Oswestry Disability Index

KW - Short Form-36

KW - Spine

KW - Spondylosis

KW - Weight loss

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