Does extreme weight loss after bariatric surgery alter spinopelvic parameters and ameliorate back pain? A retrospective case study
Fırat Emin Özdemir1
, Hakan Şeşen1, İsmail Demirkale3, Doğan Öztürk2, Hakan Buluş2, Murat Altay1
1Department of Orthopedics and Traumatology, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Affiliated by Gülhane School of Medicine, Ankara, Türkiye
2Department of General Surgery, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Affiliated by Gülhane School of Medicine, Ankara, Türkiye
3Department of Orthopedics and Traumatology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Affiliated by Hamidiye School of Medicine, Istanbul, Türkiye
Keywords: Bariatric surgery, extreme, harmony, obesity, pelvic incidence, weight-loss.
Abstract
Objectives: The aim of this study was to evaluate the effect of extreme weight loss on low back pain and spinopelvic parameters.
Patients and methods: A total of 45 patients (11 males, 34 females; mean age: 40.2±9.4 years; range, 18 to 57 years) who had bariatric surgery between January 2018 and December 2021 were retrospectively analyzed. Radiological spinopelvic parameters including lumbar lordosis (LL), pelvic incidence (PI), spinopelvic harmony (when PI is within LL±10°), pelvic tilt (PT) and sacral slope (SS) were evaluated pre- and postoperatively. Clinical outcomes were assessed using the Visual Analog Scale-Back Pain (VAS-BP) and Oswestry Disability Index (ODI).
Results: The mean BMI loss at the end of the first year after surgery was 28.1±6.7% (range, 21 to 36%). The mean PI was 55.75°±12.47° preoperatively and 53.64°±11.86° at one year and the difference was -3.10°±5.25 (p=0.02), 1.10°±4.95° for PT (p=0.46), -2,70°±3.50° for SS (p<0.001), and 3.1±6.55 for LL (p<0.001). At one year, spinopelvic harmony remained unchanged in 31 patients, nine patients regained harmony, and was lost in five patients who had previously. No significant correlation between alterations in spinopelvic alignment and ODI scores was shown (p<0.05). The mean VAS-BP score was 40±30 mm preoperatively, and 20±3.5 mm postoperatively, indicating a difference of -39±29.5 (p<0.001). The mean ODI was 34.71±20.87 preoperatively, and 16±24 postoperatively, indicating a difference of -15±13 (p<0.001). Subgroup analyses showed that the change in SS was more pronounced with regard to PT change, particularly in young and female patients with >10 kg/m2 reduction in BMI (p<0.001).
Conclusion: Weight loss after bariatric surgery improves lower back pain leading to changes in PT without affecting SS and altering PI.
Citation: Özdemir FE, Şeşen H, Demirkale İ, Öztürk D, Buluş H, Altay M. Does extreme weight loss after bariatric surgery alter spinopelvic parameters and ameliorate back pain? A retrospective case study. Jt Dis Relat Surg 2024;35(3):603-609. doi: 10.52312/jdrs.2024.1683.
The study protocol was approved by the Keçiören Training and Research Hospital Clinical Research Ethics Committee (date: 24.11.2020, no: 2084). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Idea/concept: İ.D.; Design: HŞ.; Control/supervision, literature review, critical review: İ.D., H.Ş.; Data collection and/or processing, materials: F.E.Ö., D.Ö., H.B.; Writing the article, analysis and/or interpretation: F.E.Ö., M.A.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.