Journal Reports

The Spine Journal 13 (2013) 210–213

The Spine Journal editors present abstracts from selected articles which may be of interest to TSJ readers.

The influence of obesity on the outcome of treatment of lumbar disc

herniation: analysis of the spine patient outcomes research trial

(SPORT). Rihn JA, Kurd M, Hilibrand AS, et al. J Bone Joint Surg

Am 2013;95(1):1–8.

BACKGROUND: Questions remain as to the effect that obesity has on pa-

tients managed for symptomatic lumbar disc herniation. The purpose of

this study was to determine if obesity affects outcomes following the treat-

ment of symptomatic lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in

the Spine Patient Outcomes Research Trial for the treatment of lumbar disc

herniation. A comparison was made between patients with a body mass in-

dex of!30 kg/m2 (nonobese) (n5854) and those with a body mass index

of $30 kg/m2 (obese) (n5336). Baseline patient demographic and clinical

characteristics were documented. Primary and secondary outcomes were

measured at baseline and at regular follow-up time intervals up to four

years. The difference in improvement from baseline between operative

and nonoperative treatment was determined at each follow-up period for

both groups.

RESULTS: At the time of the four-year follow-up evaluation, improve-

ments over baseline in primary outcome measures were significantly less

for obese patients as compared with nonobese patients in both the operative

treatment group (Short Form-36 physical function, 37.3 compared with 47.7

points [p!.001], Short Form-36 bodily pain, 44.2 compared with 50.0 points

[p5.005], and Oswestry Disability Index, –33.7 compared with –40.1 points

[p!.001]) and the nonoperative treatment group (Short Form-36 physical

function, 23.1 compared with 32.0 points [p!.001] and Oswestry Disability

Index, –21.4 compared with –26.1 points [p!.001]). The one exception was

that the change from baseline in terms of the Short Form-36 bodily pain

score was statistically similar for obese and nonobese patients in the nonop-

erative treatment group (30.9 compared with 33.4 points [p5.39]). At the

time of the four-year follow-up evaluation, when compared with nonobese

patients who had been managed operatively, obese patients who had been

managed operatively had significantly less improvement in the Sciatica

Bothersomeness Index and the Low Back Pain Bothersomeness Index, but

had no significant difference in patient satisfaction or self-rated improve-

ment. In the present study, 77.5% of obese patients and 86.9% of nonobese

patients who had been managed operatively wereworking a full or part-time

job. No significant differences were observed in the secondary outcome

measures between obese and nonobese patients who had beenmanaged non-

operatively. The benefit of surgery over nonoperative treatment was not af-

fected by body mass index.

CONCLUSIONS: Obese patients realized less clinical benefit from both

operative and nonoperative treatment of lumbar disc herniation. Surgery

provided similar benefit over nonoperative treatment in obese and nonob-

ese patients.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Au-

thors for a complete description of levels of evidence.

PMID: 23192403 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23192403].

Reprinted with permission from: Rihn JA, Kurd M, Hilibrand AS, et al.

The influence of obesity on the outcome of treatment of lumbar disc her-

niation: analysis of the spine patient outcomes research trial (SPORT).

J Bone Joint Surg Am 2013;95(1):1–8. Available at: http://jbjs.org/

article.aspx?articleid51391018.

http://dx.doi.org/10.1016/j.spinee.2013.01.028

The optimal treatment of type II and III odontoid fractures in the

elderly: a systematic review. Huybregts JG, Jacobs WC, Vleggeert-

Lankamp CL. Eur Spine J 2013;22(1):1–13. Epub 2012 Sep 2.

PURPOSE: Odontoid fractures are the most common cervical spine frac-

tures in the elderly. As the population ages, their incidence is expected to

increase progressively. The optimal treatment of this condition is still the

subject of controversy. The objective of this review is to summarize and

compare the outcome of surgical and conservative interventions in the

elderly ($65 years).

METHODS: A comprehensive search was conducted in nine databases of

medical literature, supplemented by reference and citation tracking. Clin-

ical status was considered the primary outcome. Fracture union and stabil-

ity rates were considered secondary outcomes.

RESULTS: A total of nineteen studies met the inclusion criteria. All stud-

ies were performed retrospectively and were of limited quality. There was

insufficient data, especially from direct comparisons, to determine the dif-

ference in clinical outcome between surgical and conservative interven-

tions. Osseous union was achieved in 66–85 % of surgically treated

patients and in 28–44 % of conservatively treated patients. Fracture stabil-

ity was achieved in 82–97 % of surgically patients and in 53–79 % of

conservatively treated patients.

CONCLUSIONS: There was insufficient data to determine a potential dif-

ference in clinical outcome between different treatment groups. Surgically

treated patients showed higher osseous union rates compared to conserva-

tively treated patients, possibly because of different selection mechanisms.

The majority of patients appears to achieve fracture stability regardless of

the applied treatment. A prospective trial with appropriate sample size is

needed to identify the optimal treatment of odontoid fractures in the elderly

and predictors for the success of either one of the available treatments.

PMID: 22941218 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/22941218].

Reprinted with permission from: Huybregts JG, Jacobs WC, Vleggeert-

Lankamp CL. The optimal treatment of type II and III odontoid fractures in

the elderly: a systematic review. Eur Spine J 2013;22(1):1–13. Epub 2012

Sep 2. Available at: http://link.springer.com/article/10.1007/s00586-012-

2452-3.

http://dx.doi.org/10.1016/j.spinee.2013.01.029