Skip Navigation Links
Home
OrganisationExpand Organisation
Hala TujuExpand Hala Tuju
QualityExpand Quality
FellowshipExpand Fellowship
SubspecialtyExpand Subspecialty
Courses
Links
OthersExpand Others
Skip Navigation LinksHome : Subspecialty : Spine       

Spine:
15 July 2011 - Volume 36 - Issue 16 - p 1320–1325
2011 Young Investigator Award Winner: Increased Fat Mass Is Associated With High Levels of Low Back Pain Intensity and Disability

Urquhart, Donna M. PhD*; Berry, Patricia B BiomedSci (Hons)*; Wluka, Anita E. MBBS, FRACP, PhD*; Strauss, Boyd J. MBBS, FRACP, PhD†; Wang, Yuanyuan MD, PhD*; Proietto, Joseph MBBS, FRACP, PhD‡; Jones, Graeme MD, MBBS, FRACP§; Dixon, John B. MBBS, FRACP, PhD¶; Cicuttini, Flavia M. MBBS, FRACP, PhD*

Abstract

Study Design. A cross-sectional study.

Objective. To determine whether body composition is associated with low back pain intensity and/or disability.

Summary of Background Data. The relationship between obesity and low back pain and disability is unclear. No study has examined the role of body composition in low back pain and disability.

Methods. A total of 135 participants (25–62 years), with a range of body mass indices (18–55 kg/m2), were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed the Chronic Back Pain Grade Questionnaire, which examines individuals' levels of low back pain intensity and disability. Body composition was assessed using dual radiograph absorptiometry.

Results. Body mass index was associated with higher levels of back pain intensity (Odds ratio [OR] = 1.35; 95% confidence interval [CI] = 1.09, 1.67) and disability (OR = 1.66; 95% CI = 1.31, 2.09). Higher levels of pain intensity were positively associated with total body (OR = 1.19; 95% CI = 1.04, 1.38) and lower limb fat mass (OR = 1.51; 95% CI = 1.04, 2.20), independent of lean tissue mass. There were also positive associations between higher levels of low back disability and total body (OR = 1.41; 95% CI = 1.20, 1.67) and upper (OR = 1.67; 95% CI = 1.27, 2.19) and lower (OR = 2.29; 95% CI = 1.51, 3.49) limbs fat mass. Similar relationships were observed with trunk, android, and gynoid fat mass. After adjusting for confounders, no measures of lean tissue mass were associated with higher pain intensity or disability (P > 0.10).

Conclusion. Greater fat, but not lean tissue mass, was associated with high levels of low back pain intensity and disability. Longitudinal investigation is needed to determine whether fat mass is predictive of low back pain and disability, as this may have important implications for further prevention strategies. Understanding the mechanism for these relationships may provide novel approaches to managing low back pain.





Spine
Issue: Volume 36(4), 15 February 2011, p E274–E281


Trends in the Use of Bone Morphogenetic Protein as a Substitute to Autologous Iliac Crest Bone Grafting for Spinal Fusion Procedures in the United States

Lad, Shivanand P. MD, PhD; Nathan, Jay K. BA; Boakye, Maxwell MD

 

Study Design. Analysis of Nationwide Inpatient Sample (NIS) database for data related to spinal fusion procedures.

 

Objective. To identify trends in the use of bone morphogenetic protein (BMP) versus iliac crest bone grafts in various spinal fusion procedures performed in the United States, explore stratification by patient demographics, and analyze the impact on treatment cost.

 

Summary of Background Data. BMP has been shown to achieve better clinical outcomes in anterior lumbar interbody fusions procedures, which led to its Food and Drug Administration approval for this indication in 2002. Since then, significant off-label use has occurred, without a full description of the results.

 

Methods. We searched the NIS for data relating to BMP administration or iliac crest bone grafting in a variety of spinal fusion procedures performed from 1993 to 2006, based on International Classification of Diseases, Ninth Revision classification. The NIS is the largest all-payer inpatient care database, with demographic, outcome, and cost data from approximately eight million annual patient discharges throughout the United States. Demographics among patients treated with BMP versus iliac crest bone graft were compared to reduce the likelihood of bias in the analysis.

 

Results. BMP became applied more frequently in each type of spinal fusion procedure examined over our study period, with the exception of anterior lumbar interbody fusions. Patients receiving iliac crest bone grafts versus BMP exhibited very similar demographic characteristics, including age, socioeconomic status, and type of health care setting. Although BMP typically increased the cost of the procedure itself, it improved outcomes and shorter hospital stays often provided a net benefit.

 

Conclusion. BMP is increasingly being used in spinal fusion procedures, including ones for which it is not officially approved, because of the surgical and postsurgical benefits it provides. Given the morbidity that this may entail, monitoring outcomes trends will help to inform guidelines for BMP use and ensure that its benefits continue to outweigh its costs.