IMPACT OF RAPID WEIGHT LOSS AFTER BARIATRIC SURGERY ON LOW BACK PAIN
Keywords:
Bariatric surgery, low back ache, rapid weight lossAbstract
Background: Obesity raises the incidence of low back pain in overweight persons, whereas losing weight should alleviate their symptoms. However, the effects of obesity on the lumbar spine are more controversial & Despite the fact that obese people with persistent low back pain are routinely urged to reduce weight, the link between the two medical conditions is yet unknown. Aim: The goal of this study is to see the effect of rapid weight reduction on the development of LBP. Patients and Methods: a prospective study of 69 obese patients with persistent axial low back pain who were scheduled for bariatric surgery was recruited in this research during a 12-month follow up. Preoperative data was obtained; Age, height, medical comorbidities, weight, and BMI were among the demographic data collected. The Visual Analog Scale (VAS) for axial low back pain was used as an outcome measure. Follow up was done at 1, 3 and 6 months, and at 1 year following the surgery; the patients' postoperative demographic data were obtained. Results:69 patients were included in this study 23(33%) males and 46(67%) females ,all underwent bariatric surgery, the patients weights rages from 112kg to 164 kg preoperative, reduced to 89 to 132 kg, their ages range between 28 to 57 years old, their BMI (body mass index) was between 39to 54 which reduced to a range between 29 to 40, the visual analog score of the patients regarding the backache was 4 to 7 preoperative which is become 2 to 7 postoperative in a fact that 22 (31.9%) of the patients started to complain from a real backache postoperatively.36 patients (52%) get improvement in their LBP postop. , and 11 patients (15%) had no significant changes in their LBP. Conclusion: This study shows that significant weight loss following bariatric surgery can lead to significant relief of pre-existing back discomfort in nearly most of the patients & on the contrary about one third of the patients may even get worse.
References
Baskin ML, Ard J, Franklin F, Allison DB. Prevalence of obesity in the United States. Obes Rev. 2005; 6: 5-7.
Grossschadl F, Freidl W, Rásky E, Burkert N, Muckenhuber J, Stronegger WJ. A 35-year trend analysis for back pain in Austria: The role of obesity. PLoS One. 2014; 9: e107436
] Liuke M, Solovieva S, Lamminen A, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond) 2005;29:903–8.
Manchikanti L, Pampati V, Singh V, Beyer C, Damron K, Fellows B. Evaluation of the role of facet joints in persistent low back pain in obesity: a controlled, prospective, comparative evaluation. Pain Physician 2001;4:266–72
O’Neill TW, McCloskey EV, Kanis JA, et al. The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol 1999;26:842–8
Biering-Sorensen F, Hansen FR, Schroll M, Runeborg O. The relation of spinal x-ray to low-back pain and physical activity among 60-yearold men and women. Spine 1985;10:445–51.
Lean ME, Han TS, Seidell JC. Impairment of health and quality of life in people with large waist circumference. Lancet 1998;351:853–6.
Mirtz TA, Greene L. Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question. Chiropr Osteopat 2005;13:2
Verbunt JA, Seelen HA, Vlaeyen JW, et al. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 2003;7:9–21.
van Tulder M, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol 2002;16:761–75
van Tulder MW, Koes BW, Assendelft WJ, Bouter LM, Maljers LD, Driessen AP. [Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID’s, back schools and behavioral therapy effective; traction not effective; results of systematic reviews]. Ned Tijdschr Geneeskd 2000;144:1489–94
Felson DT. Weight and osteoarthritis. Am J Clin Nutr 1996;63 (3 Suppl):430S–2S
] Singla AK, Stojanovic M, Barna S, Meyer MA, Carragee EJ. Persistent low back pain/Dr. Carragee replies. N Eng J Med 2005;353:956–7
Liuke, M.; Solovieva, S.; Lamminen, A.; Luoma, K.; Leino-Arjas, P.; Luukkonen, R.; Riihimäki, H. Disc degeneration of the lumbar spine in relation to overweight. Int. J. Obes. 2005, 29, 903–908.
Samartzis, D.; Karppinen, J.; Chan, D.; Luk, K.D.K.; Cheung, K.M.C. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: A population-based study. Arthritis Rheum. 2012, 64, 1488–1496.
Urquhart, D.M.; Kurniadi, I.; Triangto, K.; Wang, Y.; Wluka, A.E.; O’Sullivan, R.; Jones, G.; Cicuttini, F.M. Obesity is associated with reduced disc height in the lumbar spine but not at the lumbosacral junction. Spine 2014, 39, E962–E966.
DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007; 356: 2176-2183.
Joaquim, A.F.; Helvie, P.; Patel, A.A. Bariatric surgery and low back pain: A systematic literature review. Glob. Spine J. 2019, 10, 102–110.
Stefanova, I.; Currie, A.C.; Newton, R.C.; Albon, L.; Slater, G.; Hawkins, W.; Pring, C. A meta-analysis of the impact of bariatric surgery on back pain. Obes. Surg. 2020, 30, 3201–3207.
Lake JK, Power C, Cole TJ. Back pain and obesity in the 1958 British birth cohort. Cause or effect? J Clin Epidemiol 2000; 53: 245-50
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010; 171: 135-154.
Martin KS, Ferris AM. Food insecurity and gender are risk factors for obesity. J Nutr Educ Behav 2007;39:31–6.
Mascie-Taylor CG, Goto R. Human variation and body mass index:a review of the universality of BMI cut-offs, gender and urban-rural differences, and secular changes. J Physiol Anthropol 2007;26:109–12.
Averbukh Y, Heshka S, El-Shoreya H, et al. Depression score predicts weight loss following Roux-en-Y gastric bypass. Obes Surg 2003;13: 833–6
Velcu LM, Adolphine R, Mourelo R, Cottam DR, Angus LD. Weight loss, quality of life and employment status after Roux-en-Y gastric bypass: 5-year analysis. Surg Obes Relat Dis 2005;1:413–6; discussion 417
Padwal, R.; Klarenbach, S.; Wiebe, N.; Birch, D.; Karmali, S.; Manns, B.; Hazel, M.; Sharma, A.M.; Tonelli, M. Bariatric surgery: A systematic review and network meta-analysis of randomized trials. Obes. Rev. 2011, 12, 602–621.
Buchwald, H.; Avidor, Y.; Braunwald, E.; Jensen, M.D.; Pories, W.; Fahrbach, K.; Schoelles, K. Bariatric surgery: A systematic review and meta-analysis. JAMA 2004, 292, 1724–1737.
isbud, M.V.; Shapiro, I.M. Role of cytokines in intervertebral disc degeneration: Pain and disc content. Nat. Rev. Rheumatol. 2014, 10, 44–56.
Wuertz, K.; Haglund, L. Inflammatory mediators in intervertebral disk degeneration and discogenic pain. Glob. Spine J. 2013, 3, 175–184.
Podichetty, V.K. The aging spine: The role of inflammatory mediators in intervertebral disc degeneration. Cell. Mol. Boil. 2007, 53, 4–18.
Vismara, L.; Menegoni, F.; Zaina, F.; Galli, M.; Negrini, S.; Capodaglio, P. Effect of obesity and low back pain on spinal mobility: A cross sectional study in women. J. Neuroeng. Rehabil. 2010, 7, 3.
Skaf, G, Elias, E, Nasser, Z, Khoury, R, Hitchon, P. Worsening back pain after bariatric surgery: the impact of acute weight loss on the spine. Remed Open Access. 2017;2:1046.
Tsuritani I, Honda R, Noborisaka Y, Ishida M, Ishizaki M, YamadaY. Impact of obesity on musculoskeletal pain and difficulty of daily movements in Japanese middle-aged women. Maturitas. 2002; 42: 23-30
Daggfeldt K, Thorstensson A. The mechanics of back-extensor torque production about the lumbar spine. J Biomech. 2003; 36: 815-825.
Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. In vivo measurement of the effect of intra-abdominal pressure on the human spine. J Biomech. 2001; 34: 347-353.
Daggfeldt K, Thorstensson A. The role of intra-abdominal pressure in spinal unloading. J Biomech. 1997; 30: 1149-1155.
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