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Body Mass Index and Risk for Clinical Lumbar Spinal Stenosis: A Cohort Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
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2015 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 18, 1451-1456 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. A prospective cohort study that used a Swedish nationwide occupational surveillance program for construction workers (period of registration from 1971 to 1992). In all, 364,467 participants (mean age at baseline 34 yr) were included in the study. Objective. To determine whether overweight and obesity are associated with a higher risk of lumbar spinal stenosis (LSS). Summary of Background Data. During recent decades, LSS has become the most common indication for spine surgery, a change that coincides with a higher prevalence of obesity. Methods. A diagnosis of LSS was collected through individual linkage to the Swedish National Patient Register through December 31, 2011. Poisson regression models were employed to estimate multivariable-adjusted incidence rate ratios (IRRs) for LSS. Results. At baseline, 65% had normal weight (BMI [body mass index]: 18.5-24.99 kg/m(2)), 29% were overweight (BMI: 25-29.99 kg/m(2)), 5% were obese (BMI >= 30 kg/m(2)), and 2% were underweight (BMI <18.5 kg/m(2)). During 11,190,944 person-years of follow-up, with a mean of 31 years, 2381 participants were diagnosed with LSS. Compared with normal weight individuals, obese workers had an IRR of 2.18 (95% confidence interval, 1.87-2.53) for LSS and overweight workers had an IRR of 1.68 (95% confidence interval, 1.54-1.83). Workers who were underweight halved their risk of LSS (IRR: 0.52, 95% confidence interval, 0.30-0.90). Conclusion. Obese and overweight persons are at a higher risk of developing LSS. Furthermore, our results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS. Level of Evidence: 3

Place, publisher, year, edition, pages
Wolters Kluwer, 2015. Vol. 40, no 18, 1451-1456 p.
Keyword [en]
Bygghalsan, BMI, body mass index, cohort study, LSS, lumbar spinal stenosis, obesity, overweight, spine surgery
National Category
URN: urn:nbn:se:uu:diva-264041DOI: 10.1097/BRS.0000000000001038ISI: 000361107100009OAI: oai:DiVA.org:uu-264041DiVA: diva2:859245
Available from: 2015-10-06 Created: 2015-10-05 Last updated: 2015-11-10Bibliographically approved
In thesis
1. Lumbar spinal stenosis: Body mass index and the patient's perspective
Open this publication in new window or tab >>Lumbar spinal stenosis: Body mass index and the patient's perspective
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During recent decades, lumbar spinal stenosis (LSS) has become the most common indication for spine surgery, a change that coincides with a higher worldwide prevalence of overweight and obesity. Thus, surgical treatment of LSS in the overweight and obese population is common and increasing in scope.

The overall aim of this thesis was to investigate whether body mass index (BMI) is related to the development of LSS, and whether BMI is linked to outcome after surgery for LSS. We further evaluated whether there are specific experiences of LSS from a patient perspective.

Data were obtained for all patients registered in the Swedish Spine Register who had undergone surgery for LSS between January 1, 2006 and June 30, 2008. After adjusting for differences in baseline characteristics, patients with obesity showed both poorer results after surgery and a higher rate of dissatisfaction than patients with normal weight (odds ratio 1.73; 95% confidence interval, CI, 1.36-2.19).

Furthermore, patients with obesity in the cohort reported modest weight loss at follow-up (2.0 kg; 95% CI, 1.5-2.4), and only 8% reported a clinical important weight loss 2 years after surgery.

Our analysis of 389,132 construction workers, showed that overweight (incidence rate ratio, IRR 1.68; 95% CI, 1.54-1.83) and obesity (IRR 2.18; 95% CI, 1.87-2.53) were associated with an increased future risk in developing LSS when compared with patients with normal weight.

To gain insight into the patients' perspective of LSS, we performed interviews with 18 patients who were on a waiting list for LSS surgery. The transcripts, analyzed with content analysis, revealed that living with LSS is a physical, mental and social challenge in which resources to cope with the condition are of major importance.

In summary, obesity is associated with poorer results after surgery, and patients with obesity report modest weight loss during follow-up. In addition, obesity is associated with an increased risk to develop LSS. Our findings revealed that being a patient with LSS, naturally involves considerable suffering and pain, but it also implies being a person with his or her own resources who is able to cope with these adverse conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 70 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1148
Antonovsky, back pain, BMI, body mass index, Bygghalsan, cohort study, coping, EQ-5D, excess weight, leg pain, LSS, lumbar spinal stenosis, obesity, ODI Oswestry disability index, overweight, patient-centered, patient-physician relationship, patient-perspective, patient-related-outcome-measure, PROMs, qualitative study, spinal stenosis, salutogenesis, salutogenic, sciatica, spine surgery, suffering, Swedish spine register, Swespine, VAS, weight loss, weight change
National Category
Research subject
urn:nbn:se:uu:diva-264589 (URN)978-91-554-9376-9 (ISBN)
Public defence
2015-12-04, Rosénsalen, Akademiska barnsjukhuset, ingång 95-96, 751 85, Uppsala, 13:00 (Swedish)
Available from: 2015-11-06 Created: 2015-10-15 Last updated: 2016-04-20

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