Bariatric bypasses contribute to loss of bone mineral density but reduce axial back pain in morbidly obese patients considering spine surgery
- Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, New York, USA
Nancy E. Epstein
Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, New York, USA
DOI:10.4103/2152-7806.198740Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nancy E. Epstein. Bariatric bypasses contribute to loss of bone mineral density but reduce axial back pain in morbidly obese patients considering spine surgery. 19-Jan-2017;8:13
How to cite this URL: Nancy E. Epstein. Bariatric bypasses contribute to loss of bone mineral density but reduce axial back pain in morbidly obese patients considering spine surgery. 19-Jan-2017;8:13. Available from: http://surgicalneurologyint.com/surgicalint_articles/bariatric-bypasses-contribute-to-loss-of-bone-mineral-density-but-reduce-axial-back-pain-in-morbidly-obese-patients-considering-spine-surgery/
Background:Many spine surgeons recommend stringent weight loss, including bariatric bypass procedures, prior to “elective” spine surgery (should not be for axial back pain alone) in morbidly obese patients (defined by a body mass index (BMI) of >40 mg/kg2 or >35 mg/kg2 with two or more major comorbidities) to reduce their greater risk for major perioperative complications. Although bypasses typically lead to marked weight reduction and even reduced axial back pain, they also promote unrecognized and often insufficiently treated vitamin D deficiency and loss of bone mineral density.
Methods:Morbidly obese patients who are under consideration for “elective” spine operations (other than for back pain alone) are often told to lose weight. Some choose to undergo bariatric bypass procedures, but are unaware of the potential risks/complications of these procedures.
Results:Within the first 2 years following most bariatric bypass procedures, patients experience not only marked loss of weight and muscle mass, but also significant vitamin D deficiency and loss of bone mineral density, increasing their susceptibility to fractures. Nevertheless, some patients also experience a sufficient reduction of axial back pain to avoid spinal surgery.
Conclusions:Morbidly obese patients under consideration for “elective” spine surgery may undergo bariatric bypass procedures that lead to a significant reduction of vitamin D levels and loss of bone mineral density. However, potential benefits may include a sufficient reduction of axial back pain to avoid surgery in a select subset of patients altogether.
Keywords: Bariatric surgery, bone, bypass, morbid obesity, spine surgery
Many spine surgeons recommend that patients with morbid obesity (body mass index (BMI) of >40 mg/kg2 or >35 mg/kg2 with two or more major comorbidities) warranting “elective” surgery undergo significant weight reduction prior to spine surgery. “Elective” spine surgery in these patients with significant neurological/radiographic pathology (not for pain alone, non-emergent) may result in major life-threatening complications. Therefore, with the help of their internists, these patients may weigh the pros and cons of bariatric bypass procedures. Nevertheless, they should be aware of the bariatric bypass risks; significant decreases in Vitamin D level and loss of bone mineral density (BMD) that increases the risk of fractures. An added unanticipated benefit, however, may be sufficient alleviation of axial back pain to avoid, in some patients with lesser deficits, spine surgery altogether.
Morbidly obese patients and their spine surgeons should be familiar with the markedly increased frequency of adverse events/medical/surgical complications associated with spine surgery. As this knowledge prompts more spine surgeons to first recommend stringent weight loss, patients and their medical consultants must choose among the myriad of weight loss measures that now include bariatric bypasses.
Morbidly obese patients are at greater risk for major complications/adverse events when undergoing elective spine surgery.[
BARIATRIC BYPASS SURGERY CONTRIBUTES TO SIGNIFICANT LOSS OF BONE MINERAL DENSITY AND DECREASED VITAMIN D LEVELS WITHIN FIRST 2 POSTOPERATIVE YEARS
Bariatric bypass procedures result not only in marked weight loss/reduction in muscle mass in the first postoperative year, but also in significant vitamin D deficiency and progressive loss of BMD continuing into the second postoperative year.[
Roux-en-Y gastric bypasses similarly contributed to reductions of BMD and vitamin D deficiency.[
An unanticipated benefit of bariatric surgery, in addition to weight loss, was the potential for alleviating axial back pain in select patients [
As many spine surgeons are increasingly recommending stringent weight loss for morbidly obese patients under consideration for “elective” spine surgery (those with significant neurological/radiographic deficits), patients are increasingly choosing bariatric bypass procedures. Nevertheless, both the morbidly obese patients and their potential surgeons must be aware that these operations not only contribute to significant vitamin D deficiency and decreases in BMD, but may also reduce axial back pain, which may be sufficient in some cases to avoid spine surgery altogether.
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