Comparison of functional outcomes and patient satisfaction in patients with lumbar canal stenosis with and without concomitant obesity following lumbar decompression surgery and their correlation with BMI.

Background: Obesity is an important predictor of development of Lumbar canal stenosis (LCS) and its symptoms. LCS further restricts the mobility of the patient and a vicious cycle develops. The operative decision on patients with LCS and obesity is a matter of debate. Hence, we attempted to compare changes in body mass index and patient satisfaction in patients with LCS with and without concomitant obesity, undergoing spinal decompression surgery.

Methods: Patients undergoing decompression for LCS between 1st June 2019 to 31st May 2020 were included. Baseline characteristics including age, sex, co-morbidities, BMI, self-recorded maximal walking distance (SR-MWD) and Oswestry disability index score (ODI) were recorded. All patients were followed up prospectively at 1 year post surgery. Satisfaction was recorded on a five-point Likert scale. Participants were classified into non obesity (group 1) and obesity (group 2) groups according to JAPI and WHO classification and compared.

Results: 55 patients met the inclusion criteria, 23 in group 1 and 32 in group 2. Group 2 showed a mean decrease in BMI of 0.95 ± 1.32 kg/m while other group had an increase of 0.14 ± 1.31 kg/m (p = 0.021). Significant weight change was seen in 31.3 % group 2 vs 8.7 % group 1 patients which was significant (p = 0.046). Pre operative BMI positively correlated with change in BMI after surgery (r = 0.406, p = 0.001) and with percentage weight reduction (r = 0.321, p = 0.017). Both the groups were comparable in improvement in ODI and SR-MWD scores and patient satisfaction.

Conclusion: Patients with obesity achieve significant reduction in weight and BMI following decompression surgery for LCS. It will further prevent other health conditions attributed to obesity. Both the groups were comparable in ODI, SR-MWD and satisfactory outcome following surgery. Hence obesity should not be a deterring factor for surgical consideration for patients with lumbar canal stenosis.