Julian Mobley*, Martin Arhin, Kristina Stanson PA-C, Nadine Kramer and Lloyd A Hey

The University of North Carolina School of Medicine 2 Hey Clinic for Scoliosis and Spine Care

*Corresponding Author: Julian Mobley, The University of North Carolina School of Medicine 2 Hey Clinic for Scoliosis and Spine Care.

Received: July 05, 2023; Published: August 23, 2023

Abstract

Degenerative spine disease, such as spinal stenosis, is a common condition characterized by the narrowing of the spinal canal, resulting in the compression of the spinal cord and nerve roots. Surgical interventions are frequently recommended, but alternative non-invasive treatment options are being explored. Previous studies suggest a correlation between obesity and spinal stenosis; however, further investigation is needed to elucidate the specific effects of weight loss on this condition. This case report presents two patients, aged 73 and 23, who successfully managed their spinal stenosis through a conservative treatment plan focused on weight loss and lifestyle modifications. The treatment plan involved providing a newly developed one-page decision aid tool combined with a 10–20-minute educational dialogue between the surgeon and patients. This process guided the patients in adopting a low-carbohydrate diet and engaging in regular exercise, resulting in significant weight loss and notable improvements in their symptoms and mobility. These outcomes illustrate the potential of weight loss as an alternative to surgery and its ability to improve the quality of life of individuals with degenerative spine disease.

As a result of the rise in the incidence of spinal stenosis and obesity, practitioners should consider weight loss as a possible primary treatment. This case report emphasizes the importance of considering weight loss as a conservative treatment for spinal stenosis and how physicians can use a motivational approach with an evidenced-based decision-aid tool to guide patients. More research including larger prospective studies, is warranted to understand better the role of weight loss in managing spinal stenosis and related degenerative spinal conditions.

Keywords: Spinal Stenosis; Spondylolisthesis; Neurogenic Claudication; Decision Aid Tool; Obesity; Weight Loss

References

1. Ravindra Vijay , et al. "Degenerative lumbar spine disease: estimating global incidence and worldwide volume”. Global Spine Journal 8.8 (2018): 784-794.
2. Issack Paul , et al. "Degenerative lumbar spinal stenosis: evaluation and management”. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 20.8 (2012): 527-535.
3. Vining Robert , et al. "Current evidence for diagnosis of common conditions causing low back pain: systematic review and standardized terminology recommendations”. Journal of Manipulative and Physiological Therapeutics 42.9 (2019): 651-664.
4. Katz Jeffrey , et al. "Diagnosis and management of lumbar spinal stenosis: a review”. Jama 327.17 (2022): 1688-1699.
5. Katz Jaffrey , et al. "Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis”. Spine 20.10 (1995): 1155-1159.
6. Bagley Carlos, et al. "Current concepts and recent advances in understanding and managing lumbar spine stenosis”. F1000Research 8 (2019).
7. Nagler Willibald and Harris S Hausen. "Conservative management of lumbar spinal stenosis: Identifying patients likely to do well without surgery”. Postgraduate Medicine 4 (1998): 69-88.
8. Mastrogianni , et al. "Spinal Stenosis Pain: Primary Management Spinal Stenosis: Primary Management”. Acta Orthopaedica Et Traumatologica Hellenica 72.2 (2021): 207-216.
9. Costandi Shrif., et al. "Lumbar spinal stenosis: therapeutic options review”. Pain Practice 1 (2015): 68-81.
10. Jain Deeptee and Sigurd "Effect of obesity on the development, management, and outcomes of spinal disorders”. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 27.11 (2019): e499-506.
11. Wang Youfa., et al. "Has the prevalence of overweight, obesity and central obesity leveled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic”. International Journal of Epidemiology 3 (2020): 810-823.
12. Khoueir , et al. "Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery”. The Spine Journal 9.6 (2009): 454-463.
13. Rodriguez-Martinez Nestor G., et al. "The role of obesity in the biomechanics and radiological changes of the spine: an in vitro study”. Journal of Neurosurgery: Spine 4 (2016): 615-623.
14. Roffey Darren M., et al. "Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults”. The spine journal 3 (2011): 197-204.
15. Lewandrowski Kai-Uwe., et al. "Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis”. Journal of Personalized Medicine 5 (2023): 710.
16. Ponkilainen Ville T., et al. "National trends in lumbar spine decompression and fusion surgery in Finland, 1997-2018”. Acta Orthopaedica 2 (2021): 199-203.
17. Deyo Richard , et al. "Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults”. Jama 303.13 (2010): 1259-1265.
18. Carreira Dominic., et al. "Obesity Treatment in Orthopaedic Surgery”. Journal of the American Academy of Orthopaedic Surgeons 24 (2022): e1563-1570.
19. Brown Avery E., et al. "Obesity negatively affects cost efficiency and outcomes following adult spinal deformity surgery”. The Spine Journal 4 (2020): 512-518.
20. Cofano , et al. "Obesity and spine surgery: a qualitative review about outcomes and complications. Is it time for new perspectives on future research?" Global Spine Journal 12.6 (2022): 1214-1230.
21. Weinstein James N., et al. "Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT)”. Spine 14 (2010): 1329.
22. Liuke M., et al. "Disc degeneration of the lumbar spine in relation to overweight”. International Journal of Obesity 8 (2005): 903-908.
23. Lee Sang , et al. "Relationship between obesity and lumbar spine degeneration: a cross-sectional study from the fifth Korean national health and nutrition examination survey, 2010-2012”. Metabolic Syndrome and Related Disorders 17.1 (2019): 60-66.
24. Shiri Rahman., et al. "Obesity as a risk factor for sciatica: a meta-analysis”. American Journal of Epidemiology 8 (2014): 929-937.
25. Piscoya JL., et al. "The influence of mechanical compression on the induction of osteoarthritis-related biomarkers in articular cartilage explants”. Osteoarthritis and Cartilage 12 (2005): 1092-1099.
26. Sairyo Koichi., et al. "Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments”. Spine 23 (2005): 2649-2656.
27. Knutsson Björn., et al. "Body mass index and risk for clinical lumbar spinal stenosis”. Spine 18 (2015): 1451-1456.
28. Briggs Matthew S., et al. "Relations of C-reactive protein and obesity to the prevalence and the odds of reporting low back pain”. Archives of Physical Medicine and Rehabilitation 4 (2013): 745-752.
29. Warren Justin , et al. "A finite element study of the relationship between upper body weight and the loads experienced by the human lumbosacral spine, and fusion instrumentation, in a standing upright posture”. Biomedical Engineering Advances 2 (2021): 100023.

Citation

Citation: Julian Mobley., et al. “Avoiding Surgery: Successful Weight Loss as an Alternative Treatment for Degenerative Spine Disease". Acta Scientific Orthopaedics 6.9 (2023): 56-60.

Copyright

Copyright: © 2023 Julian Mobley., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.