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The surgeon I went to for relief from my back pain told me to lose 75 pounds and then we can talk about surgery. If I could lose 75 pounds, I would have already done it! If I go to another surgeon, will I hear the same thing? Or is it possible to find someone to do it for me?
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There's never anything wrong with seeking a second (and sometimes third) opinion for complex medical problems like obesity. The surgeon is not trying to punish you by refusing to do the procedure until you lose weight. There are some serious complications that can occur in patients who are obese.
Obesity is defined as a body mass index (BMI) of 30 or more. Patients with a BMI of 30 or more are more likely to have problems with the anesthesia. It will be more difficult to access veins for intravenous procedures. Positioning the obese patient, changing positions, and getting him or her up and moving after surgery to avoid blood clots are important tasks but can be very difficult.
Depending on your medical condition and the type of surgery needed, it might be possible to seek out a surgeon who performs less invasive spine surgery. One procedure in particular that has had good results with patients with a high BMI is called the less invasive posterior interbody lumbar fusion or LI-PLIF.
The LI-PLIF procedure is done from the back of the spine (posterior approach). The surgeon uses surgical tools that can be inserted into the spine without making a large incision. Minimally invasive procedures make it possible to spare the muscles and ligaments from being cut into, which is what happens during the more invasive open incision technique.
The surgeon removes the spinal (facet) joints on either side of the affected segment. This does two things: 1) turns off pain signals coming from the joint and 2) provides the surgeon (and patient) with bone for the fusion site. It's a win-win situation for the patient.
The diseased disc is also removed. In its place, the surgeon inserts two metal mesh-like cages. Inside the cages are bone chips and bone dust from grinding up the bone removed from the joints. Additional bone will grow around the cage providing the strength and support of a pillar at that level.
According to the results of a recent study, putting off surgery may not be necessary with the newer minimally invasive spinal fusion procedures. Fifteen (15) patients with a BMI greater than 30 had the less invasive posterior lumbar interbody fusion (LI-PLIF). All of these individuals had tried a more conservative approach with rehab and exercise but failed to get improvement with their painful symptoms.
The results were very positive. With the less invasive posterior lumbar interbody fusion (LI-PLIF) procedure, there was less blood loss and therefore a shorter hospital stay. The less invasive technique was also credited with no blood transfusions, less pain, and faster return to full function. There were no blood clots or deaths among the 15 patients in this study.
The authors concluded that obesity (even morbid or extreme obesity) does not have to be an automatic "lose weight or no surgery" situation. Obese patients with chronic, unresponsive low back pain from degenerative disc disease can benefit from lumbar fusion.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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