The effect of increasing body mass index on the pain and function of patients with adult spinal deformity

David Christopher Kieser, Michael Charles Wyatt, Louis Boissiere, Kazunori Hayashi, Derek Thomas Cawley, Caglar Yilgor, Daniel Larrieu, Takashi Fujishiro, Ahmet Alanay, Emre Acaroglu, Frank Kleinstueck, Ferran Pellisé, Francisco Javier Sánchez Perez-Grueso, Anouar Bourghli, Jean-Marc Vital, Olivier Gille, Ibrahim Obeid, on behalf of the European Spine Study Group


Background: Both adult spinal deformity (ASD) and obesity are growing concerns internationally. This study therefore aims to determine the effect of increasing body mass index (BMI) on the pain and function of patients with ASD.
Methods: A retrospective review of prospectively collected data from a multicentre European database was undertaken. Initially a univariate analysis was performed on the effect of BMI on the initial presentation of functional scores in patients with ASD. The functional scores included the Numerical Rating Scale (NRS) back and leg score, Core Outcome Measures Index (COMI) back score, SRS22 total score, Short Form 36 (SF-36) [general health, physical component score (PCS) and mental component score (MCS)] and Oswestry Disability Index (ODI) score (including all domains). Subsequently a multivariate analysis controlling for age, sex, comorbidities, employment status, smoking status and radiological parameters [coronal cobb, coronal balance, sagittal balance, global tilt, and pelvic incidence minus lumbar lordosis (PI − LL) mismatch] was performed.
Results: A total of 1,004 patients were included in this study (166 male, 838 female). On univariate analysis a statistically significant (P<0.05) moderate correlation between NRS leg pain, ODI (walking, standing, sex life, social life and total score), SF-36 (physical component), sagittal balance, global tilt and age were recognised (P<0.05). A statistically significant low correlation was identified for all other outcomes, except coronal balance (P=0.640). On multivariate analysis BMI remained significantly related to all functional outcomes except ODI-pain and ODI-travelling (P>0.05).
Conclusions: Increasing BMI has a significant adverse effect on the pain and functioning of patients with ASD. Clinicians should recognise this association and treat patients accordingly.