Evidence-Based Spine Surgery 2009; 5(4): 27-36
DOI: 10.1055/s-0028-1100874
Clinical topic
© Georg Thieme Verlag KG Stuttgart · New York

Lumbar fusion

Obesity and rates of complications associated with surgery
Further Information

Publication History

Publication Date:
30 December 2009 (online)


Evidence from four cohort studies suggests that BMI is not a significant prognostic risk factor for most outcomes measured after spinal fusion. Two studies did report a significant association of increasing BMI with risk of perioperative complications following lumbar fusion. There were no consistent findings across studies with regard to BMI and change in functional outcomes after surgery. Obese patients undergoing spinal fusion appear to achieve similar benefits to nonobese patients.

Appendix references

Clinical notes

Bryan Ashman, Australia

These studies suggest that complications associated with lumbar spine fusion surgery are higher in obese patients than in those patients with a normal BMI (20 – 25), but the functional outcomes after surgery are similar in both groups.

Most spine surgeons would intuitively agree with these findings as personal experience shows that obese spinal surgery patients have longer operating times, more blood loss, more wound infections, and slower mobilisation than thinner patients.

However it is reassuring that the long term functional outcomes are the same for obese and normal weight patients. A previous study found no difference in functional outcomes between obese and normal patients following a function restoration program for chronically disabled patients following work-related back injuries, even though obese patients were over-represented in this group of patients [1].

A review of published reports on the link between obesity and low back pain between 1965 and 1997 only found a weakly positive ratio [2]. So even though obese spine patients require counselling about the increased risk of complications they can be reassured about the likelihood of successful outcomes after spine surgery.

Interestingly, other studies suggest that obesity seems to be protective for bone mass loss and fractures, including vertebral fractures.


  1. Mayer T, Aceska A, Gatchel RJ (2006)
    Is obesity overrated as a „risk factor” for poor outcomes in chronic occupational spinal disorders?
    Spine; 31 (25): 2967 – 2972.

  2. Leboeuf-Yde C (2000)
    Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies.
    Spine; 25 (2): 226 – 237.