How strong is your spine?

Dr Arvind Kulkarni
Sunday, 31 December 2017

Dr Arvind Kulkarni, head of Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital, gives a peek into how obesity affects your spine and ways to avoid complications

Sunita Rao, 59, who was morbidly obese (BMI 46.6) had unbearable back pain that would radiate down to her lower limbs. In fact, she had been suffering severe disability and activity restriction due to both strained back and obesity for the last two years. She tried painkillers too but that would help to subside her pain only for a few hours. On diagnosis, her reports revealed her to be an advanced case of Lumbar Spinal Stenosis (LSS) for which the only possible treatment is a decompression fusion surgery. But higher the body mass index (BMI), the greater is the chance of experiencing complexity during spine surgery. So, the lady was advised to go ahead with a safer and minimally invasive spinal stenosis surgery with spinal navigation technique for better outcome and quicker recovery.

How obesity leads to spine problems
Patients who are overweight or obese and suffer from back pain or spinal problems may not be aware that it’s their excess weight that is actually contributing to their spine problems. Little do they realise that obesity is like a vicious circle because if they exercise they might experience fatigue, shortness of breath, etc, and if they don’t; then it may cause chronic conditions of back and spine as lack of exercise contributes to more weight which exerts more stress on spine.

Basically, for people who are overweight, every extra inch adds strain to the muscles and ligaments in the back as due to obesity the spine tends to become tilted and stressed unevenly to an extent that over time, the back may lose its proper support. Some of the most common obesity-related problems include musculoskeletal and joint related pains like arthritis of spine, sciatica and low back pain from a herniated disc, problem of degenerative disc, and so on.

Obesity aggravates back pain and problems in particular because the extra weight around the stomach pulls the pelvis forward which in return strains the lower back, thus causing pain. Also, the vertebral disc of an obese individual gets weak or damaged much faster causing a variety of problems. So, if we put it in a layman’s language, it’s our spine that supports much of the body’s weight. Extra weight means extra pressure and stress on the spine which causes degenerative changes in the vertebral column. And, for those who are morbidly obese, chances of potential injury to the spine are even greater. Excess weight can even worsen pre-existing spinal issues.

Obesity and back surgery
When it comes to obese patients (especially the ones whose BMIs are higher than 30), they are certainly at a higher risk for complications and infections during spine surgery as compared to patients who are not obese. They are even at a risk of developing perioperative complications.

Though shedding a few kilos before undergoing back surgery may improve the healing process post surgery, it may still pose tremendous risk as positioning of obese patients so as to obtain adequate surgical exposure during conventional spine surgery gets challenging. Besides, its difficult to gain access to a blood vessel to start an intravenous (IV) line in such overweight cases.

But unlike the traditional or conventional spine surgery, the minimally invasive spine surgery (MIS) with navigation technique aids in adequate exposure without resorting to larger incisions which means minimal soft-tissue dissection, hence causing short recovery period and therefore, short hospital stay. Also, pain and blood loss following an MIS procedure is greatly minimised, which allows patients to resume their activities more quickly.

Another advantage of using navigation technology is that it has reduced the radiation exposure — both in case of the patient and surgical team has been tremendously reduced. Such computer-based navigation technology helps in complex procedures of spinal surgery by guiding accurate screw/implant placement, especially where visualisation is limited. Thus, the use of spinal navigation has reduced operative time, thereby making the spine surgery safer, more accurate, less invasive and preferred choice of both surgeons and patients these days.

Buck up!
The best way to avoid weight-related spine issues is to start off with a weight loss programme. In addition to keeping regular track of BMI scale, patients should chart their weight and waist measurement on regular basis. They should eat nutritious and healthy diet, avoid junk food and restrict emotional binging. Exercising daily can help to shed a few kilos, but as a general rule, obese people should avoid high-impact exercises to protect the spine and joints. With the help of an instructor, they can focus on exercises that help in strengthening of muscles. Weight loss surgery is an option for extreme cases. Keep in mind: healthy weight is a way to healthy spine!

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