Less than expected weight loss in obese patients after lumbar surgery

Many overweight and obese patients believe that they will be able to lose weight with symptom relief and increased activity after successful lumbar decompression surgery, but most maintain or increase their weight and body mass index (BMI). Weight loss may be an unrealistic expectation because obesity is an independent disease.

Garcia and colleagues reviewed the records of 63 overweight and obese patients who had undergone primary lumbar decompression for lumbar spinal stenosis. After surgery, all patients were referred for formal physical therapy. Changes in body weight and BMI after surgery were analyzed; the Zurich Claudication Questionnaire (ZCQ) was used to obtain symptom severity and physical function scores.

At follow-up, the patients' average body weight and BMI had increased significantly, by 2.48 kg and 0.83 kg/m², respectively, even though the ZCQ symptom severity and physical function scores had improved significantly (mean, 56.4% and 53.0%, respectively). Overall, 59% of the patients remained within 5% of their preoperative body weight, 35% gained 5% or more, and 6% lost 5% or more.

The authors noted that patients should be counseled preoperatively and encouraged to participate in a weight reduction program before and after undergoing the surgery.