Table 1.
Summary of the Findings of the 9 Included Articles About Low Back Pain/Functional Status Before and After Bariatric Surgery.
| Study and Level of Evidence | Objective | Methods | Results |
|---|---|---|---|
| Melissas et al,11 2003 | Evaluate the incidence and severity of low back pain before and after a BS | Case-control study with 50 morbidly obese patients and 50 nonobese patients as controls | Mean BMI before surgery was 46.7 ± 7.7 and 24 months postoperatively it was 33.6 ± 5.6 (P < .0001). |
| LOE IV | Pain status was evaluated using a questionnaire proposed by the authors | 29 obese patients (58%) with LBP before surgery and 12 patients (24%) in the lean controls (P < .01). At the 24-month follow-up, only 10 patients continued to have LBP, and their pain was less frequent and required less medication compared with the period before surgery. | |
| Follow-up: 24 months | LBP in the obese group did not correlate with increasing weight burden. | ||
| Melissas et al,12 2005 | Evaluate the intensity of back pain and the functional status before and after a BS | Cohort of 29 morbidly obese patients | VAS1 before surgery was 1.59 ± 1.86 and 2 years postoperative if was 0.32 ± 0.64 (P < .001). |
| LOE III | Pain was assessed with the VAS scale (3 categories: VAS1—current pain level, VAS2—worst pain level, and VAS3—better pain level) and functional status with the ODI, the Roland-Morris questionnaire and the Waddel Disability Index | VAS2 before surgery was 5.5 ± 1.97 and 2 years postoperative it was 2.14 ± 1.88 (P < .001). | |
| Follow-up: 24 months | VAS3 before surgery was 0.77 ± 1.11 and 2 years postoperative it was 0.09 ± 0.29 (P = .006). | ||
| The Roland-Morris questionnaire before surgery was 7.89 ± 5.11 versus 1.89 ± 2.13 (P < .001) 2 years postoperative. | |||
| The Oswestry Disability Index was 21.22 ± 15.63 versus 5.61 ± 7.51 (P < .001) 2 years postoperative. | |||
| The Waddell Disability Index was 2.81 ± 1.37 versus 0.56 ± 0.72 (P < .001) 2 years postoperative | |||
| Hooper et al13 | Evaluate the role of BS in painful musculoskeletal conditions | Longitudinal interventional study | Painful musculoskeletal complaints decreased from 100% of the patients before surgery to 48% at the final follow-up (especially in the cervical and lumbar spine and foot). |
| LOE III | 48 obese patients were included | SF-36 demonstrated improvement in all 8 domain scores after weight loss (P < .001). | |
| Outcome assessed using the Western Ontario McMaster Osteoarthritis Index (WOMAC) for pain, stiffness, and function and the SF-36 | WOMAC Composite demonstrated improvement from 150 ± 75.4 before to 49 ± 51 after surgery (P < .001). | ||
| Follow-up: 12 months | |||
| Josbeno et al14 | Evaluate the role of BS in physical function | Longitudinal interventional study | Significant improvement in the 6-Minute Walk Test (393 ± 62.08 m to 446 ± 41.39 m after; P = .003), in the Short Physical Performance Battery (11.2 ± 1.22 to 11.7 ± .57, P = .04), physical function subscale of the SF-36 (65 ± 18.5 to 84.1 ± 19.9, P = .000), the total SF-36 (38.2 ± 23.58 to 89.7 ± 15.5, P = .000), and self-reported physical function assessed with pedometer readings (2750 ± 2016.06 more steps/day, P = .003). |
| LOE III | 20 patients were assessed before and after surgery | The Numeric Pain Rating Scale score decreased significantly for low back (3.5 ± 1.8 to 1.7 ± 2.63, P = .01), knee (2.4 ± 2.51 to 1.0 ± 1.43, P = .004), and foot/ankle (2.3 ± 2.8 to 0.9 ± 2.05, P = .008) pain. | |
| Outcome assessed using the 6-Minute Walk questionnaire, the SF-36 questionnaire, and the Numeric Pain Rating Scale | Physical activity of moderate-vigorous intensity did not change significantly (P = .43) before (191.1 ± 228.23 min/walk) and after surgery (231.7 ± 230.04 min/walk), and there were no changes in the Physical Activity Self-Efficacy questionnaire or the Physical Activity Barriers and Outcome Expectations questionnaire. | ||
| Follow-up: 3 months | |||
| Khoueir et al15 | Evaluate the role of bariatric surgery in axial back pain before and after a BS | Prospective longitudinal study | A significant reduction in VAS scores was observed for axial back pain (5.2 ± 3.35 before surgery to 2.9 ± 3.1 postoperatively, P = .006), an average of a 44% decrease. |
| LOE III | 58 morbidly obese patients with chronic axial back pain | In the SF-36, patients had significant increases in mean physical health by 58% (44.5 ± 20.09 to 70 ± 26.84, P < .001), and in mean mental health by 6% (70 ± 7.14 to 73.39 ± 11.78, P < .001). | |
| Outcome was assessed using the VAS for axial back pain, the SF-36 health survey and the ODI | There was a statistically significantly decrease of 24% in physical disability using the ODI score (from 26.75 ± 16.56 before to 20.35 ± 18.71 after surgery, P = .05). | ||
| Follow-up: 12 months | |||
| Vincent et al16 | Evaluate the role of bariatric surgery in joint pain (low back, hip, knee and ankle), and quality of life before and after a BS | Prospective comparative study | At 3 months, the differences between controls was significant (P < .05) for step length, heel to heel base of support, and the percentage of time spent in single and double support during the gait cycle. |
| LOE III | 25 morbidly obese patients and 20 nonobese controls | LBP decreased by 54% (mean score changed from 5.2 to 2.4 points) and knee pain decreased in 31% (mean score changed from 5.1 to 3.5 points) (P = .05). | |
| Outcome was assessed using the VAS, the SF-36 questionnaire, and walking and stair climbing tests | Walking speed increased by 15% in the bariatric group (P < .05). | ||
| Follow-up: 3 months | The SF-36 physical component scores increased 11.8 points in the bariatric group (P < .0001). | ||
| Lidar et al17 | Evaluate the role of bariatric surgery in intervertebral disc space height, axial back pain, radicular leg pain, and quality of life before and after a BS | Prospective study | Disc height increased from 6 ± 1 mm before surgery to 8 ± 1 mm 1 year after surgery (P < .001). |
| LOE III | 30 morbidly obese patients | Preoperatively, 26 patients reported axial back pain, 16 radicular leg pain, and 15 both; despite no stenosis documented on CT scan. Axial back pain 1 year after surgery decreased significantly (from 5.70 ± 3.12 to 1.33 ± 2.13, Wilcoxon signed rank test = 175.5; P < .001), as well as radicular leg pain (from 3.46 ± 3.78 to 0.46 ± 1.10, Wilcoxon signed-rank test = 60; P < .001). | |
| Outcome was assessed using the VAS for axial and radicular pain, the SF-36 questionnaire, and the Moorehead-Ardelt (MA) questionnaires | There was no significant change of the SF-36 questionnaire before and after surgery (P = .097), but the MA questionnaire reported improvement (from 5.91 ± 1.099 to 7.91 ± 1.38, t = 8.09; P < .001). | ||
| Follow-up: 12 months | Change in BMI was correlated with improvement in leg pain. | ||
| Koulischer et al18 | Evaluate the role of bariatric surgery in low back pain and functional status before and after a BS | Prospective study | VAS was 4.1 ± 3.5 preoperatively, 3.1 ± 2.5 at 5 months, and 3.4 ± 2.1 at 22 months after surgery (P < .01). |
| LOE III | 65 morbidly obese patients | The ODI was 20.5 ± 18.1 preoperatively, 14 ± 14.5 at 5 months, and 13.8 ± 16.2 at 22 months after surgery (P < .05). | |
| Outcome was assessed using the VAS, the ODI, and the SF-36 questionnaire | The SF-36 Physical Health was 53.7 ± 22.6 preoperatively, 78.5 ± 16 at 5 months, and 74.2 ± 20.1 at 22 months after surgery (P < .01). | ||
| Follow-up: 22 months | |||
| King et al19 | Evaluate the role of bariatric surgery in pain and functional status before and after a BS | Multicenter observational study | The SF-36 scores were significantly higher for bodily pain (from 39.9 [95% CI, 39.5-40.3] to 44.8 [95% CI, 44.3-45.3] at year 3) and for physical function (from 39.9 [95% CI, 39.5-40.3] to 47.8 [95% CI, 47.4-48.3] at year 3). |
| LOE III | 2221 available for analysis (from 2428 study participants) | The WOMAC scores decreased at year 3 for knee pain (from 46.5 [95% CI, 44.9-48.1] to 26.2 (95% CI, 24.1-28.2] at year 3), hip pain (from 47.4 [95% CI, 45.6-49.2] to 25.7 [95% CI, 23.4-28.0] at year 3), knee function (from 48.6 [95% CI, 47.2-50.0] to 24.6 [95% CI, 22.7-26.6] at year 3), and hip function (from 46.7 [95% CI, 45.0-48.3] to 22.2 [95% CI, 20.0- 24.4] at year 3). | |
| Primary outcomes: improvement of ≥5 points in the SF-36 questionnaire and ≥24 seconds in the 400-meter walk time. Secondary outcomes were improvement in the Western Ontario McMaster Osteoarthritis (WOMAC) Index of more than ≥9.7 pain points and ≥9.3 function points on the transformed score | Long-Distance-Corridor Walk (LDCW): 1168 patients reported back pain preoperatively, which reduced to 750 at year 3 (P < .001). Leg pain during the LDCW reduced from 1168 patients to only 750 at year 3 too (P < .001). | ||
| Follow-up: 3 years | Before surgery, 1762 participants reported that they could not go to work or school due to back or leg pain in the proceeding 4 weeks compared with 1314 at year 3 (P < .001), pain medication (preceding week) for leg pain decreased from 2040 participants preoperatively to 1544 at year 3 (P < .001). |
Abbreviations: LOE, level of evidence; VS, bariatric surgery; BMI, body mass index; LBP, low back pain; VAS, visual analogue scale; ODI, Oswestry Disability Index; CT, computed tomography.