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Vol. 29. Num. 2.March - April 2018
Pages 57-108
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Vol. 29. Num. 2.March - April 2018
Pages 57-108
Review article
DOI: 10.1016/j.neucie.2017.12.003
Impact of obesity in the pathophysiology of degenerative disk disease and in the morbidity and outcome of lumbar spine surgery
Impacto de la obesidad en la fisiopatología de la enfermedad degenerativa discal y en la morbilidad y resultados de la cirugía de columna lumbar
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Pedro David Delgado-López
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, José Manuel Castilla-Díez
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
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Tables (4)
Table 1. Levels of obesity by BMI or Quetelet's index.
Table 2. Diseases and clinical situations directly related to obesity.
Table 3. Mediators and mechanisms linking obesity and disc degeneration.
Table 4. Summary of the impact of obesity/overweight on surgical technique, surgical morbidity, functional outcomes and mortality.
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Abstract

Obesity (BMI >30kg/m2) is a pandemic with severe medical and financial implications. There is growing evidence that relates certain metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state mediated by adipokines and other substances that favour disk disease and chronic low back pain. Obesity greatly conditions both the preoperative evaluation and the spinal surgical technique itself. Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese subjects. However, functional outcomes after lumbar spine surgery are favourable although inferior to the non-obese population, acknowledging that obese patients present with worse baseline function levels and the prognosis of conservatively treated obese cohorts is much worse. The impact of preoperative weight loss in spine surgery has not been prospectively studied in these patients.

Keywords:
Obesity
Body mass index
Degenerative disk disease
Lumbar spine surgery
Adipokines
Complications
Resumen

La obesidad (IMC>30kg/m2) es una pandemia con graves implicaciones médicas y económicas. Existe una creciente evidencia que relaciona procesos relacionados con el metabolismo del tejido adiposo, preferentemente abdominal, con un estado inflamatorio crónico de baja intensidad mediado por adipocinas y otras sustancias que favorecen la lesión discal y el dolor lumbar crónico. La obesidad condiciona en gran medida la evaluación preoperatoria y la técnica quirúrgica en cirugía de columna. Diversos metaanálisis confirman un aumento de complicaciones tras cirugía lumbar en el paciente obeso (especialmente infecciones y trombosis venosas). Sin embargo, los resultados funcionales de estas intervenciones son favorables aunque inferiores a los de la población no obesa, teniendo en cuenta que parten de valores basales inferiores y el pronóstico de los obesos tratados conservadoramente es mucho peor. El impacto de una reducción de peso preoperatoria no se ha estudiado de forma prospectiva en este tipo de pacientes.

Palabras clave:
Obesidad
Índice de masa corporal
Enfermedad degenerativa discal
Cirugía de columna lumbar
Adipocinas
Complicaciones

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