Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.</jats:p></jats:sec>

Rising prevalence of BMI ≥40 kg/m2: A high‐demand epidemic needing better documentation

“…Increasingly, changes to care environments are being needed to accommodate larger body sizes, requiring adjustments such as widened doorways, reinforced floors, suitable seats, and larger rooms. Problems featured in the health literature demonstrate the scope of challenges, such as evacuation planning, diagnostic scanning, and positioning during surgery in theatre . Documented requirements include staff training, specialist equipment provision, and development of specialist clinical protocols covering essential areas, such as tissue viability guidance .…”

“…Problems featured in the health literature demonstrate the scope of challenges, such as evacuation planning, diagnostic scanning, and positioning during surgery in theatre . Documented requirements include staff training, specialist equipment provision, and development of specialist clinical protocols covering essential areas, such as tissue viability guidance . However, issues are not restricted to health care but affect all aspects of life, including specialist housing, adapted workplace design, larger sized fashionable and safety clothing, and barriers to travelling .…”

More risks and complications for elective spine surgery in morbidly obese patients

“…[1128] One study (2013) observed the “Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma.”[28] Their 6 morbidly obese patients, who weighed over 265 pounds, and had BMIs of over 40 (range: 47.8–67.1), sustained high-speed injuries following motor vehicle accidents (MVA). Morbid obesity contributed to longer surgery, poorly fitting orthotics, suboptimal magnetic resonance (MR)/computed tomography (CT)/X-ray images including intraoperative radiographs risking wrong level surgery.…”

Trends in Inpatient versus Outpatient Anterior Cervical Discectomy and Fusion in the United States of America: An Epidemiologic and Economic Analysis

“…Currently, there is in excess of 6000 outpatient centres in operation in the USA (16). The literature is satiated with data on the epidemiology and outcomes of spine operation in a hospital-based setting (17)(18)(19)(20)(21).…”