Fat is Bad? Lumbar Discectomy in Patients with High Body Mass Index

Objective: Spine surgeons are experiencing increased morbidly obese patients with lumbar spine pathology in regular practice. There is a close association between back pain and morbid obesity, particularly due to chronic stresses on the spine. Our objective of this review of literature is to identify the difficulties encountered by the spine surgeons in lumbar spine microdiscectomy and to provide possible solutions for the same. All pre-operative, intra-operative including surgical techniques and post-operative complications with clinical outcomes are taken into consideration. Methods: obesity was defined as body mass index (BMI) more than 30kg/m2 whereas Morbidly obese are the people who have BMI more than 40kg/m2 or BMI 35kg/m2 associated with at least 2 co morbid conditions. Keywords were taken as Micro discectomy, lumbar spine disease, morbidly obese, obese, obesity related spine pathology, spinal surgery in obese, Body mass index. This review article examined articles published concerning “lumbar microdiscectomy in obese patients” on Pub Med and Google scholar. We also included some articles related to lumbar fusion surgery in obese patient. Articles in which lumbar spine surgeries operated on non-obese patients and surgeries performed at cervical and dorsal level were excluded. We included 71 articles published on the related topic Results: Review illustrated that obese patients were at higher risk of complications at all stages of management. Pre-operatively obese patients showed inferior outcome to conservative management. Health care professionals are challenged in transportation, imaging, and resuscitation procedures of obese patients because of large body fat. Intra operatively obese patients have showed increased blood loss, operative time and infection rates. Even surgeries in obese patients were technically demanding. Obese patients demonstrated inferior clinical outcomes, increased complications rates compared to non-obese patients. Minimally invasive spine surgery has shown better and promising results in lumbar discectomy. Conclusion: lumbar surgeries on obese patients is fraught with multiple challenges starting from preoperative period might through the surgical procedure and rehabilitation With the increasing availability of technology and surgical expertise, MIS has proven to be equally effective, if not better, than traditional lumbar surgeries in this group of patients. Smaller surgical incisions, early mobilization and shorter duration of hospital stay are some of the advantages of this technique Keywords: Micro discectomy, Lumbar spine disease, Morbidly obese, Obese, Obesity related spine pathology, Spinal surgery in obese, Body mass index.