Possible Complications of Back Surgery for Overweight Patients

If you're planning a back surgery soon, you may be thinking, and perhaps fretting, about all the things that could go wrong. These are called "complications." Although complications can arise from the surgery itself, with a little planning, and a lot of excellent health behavior, you may be able to steer clear of many these unwanted issues.

Complications relating to back surgery tend to occur more frequently in patients who are overweight. The unfortunate conundrum is that overweight and obese people are often the ones who need back surgery the most.

A surgeon communicating her equipment and tool needs
shapecharge / Getty Images

Types of Complications

What kinds of problems should you be concerned about if you are overweight or obese, and you plan to have back surgery soon?

A big one is making sure your healthcare provider has diagnosed you correctly. This is because getting an accurate MRI or other diagnostic film can more problematic for obese patients than for those of a healthy weight. Inaccurate films may lead to a mistaken diagnosis and the wrong surgical procedure being performed. It might lead to surgery at the wrong spinal level, as well.

And with the extra tissue to navigate through, it can be difficult for your surgeon to access the correct area of your spinal column. The same is true for placing the surgical instrument where it needs to go.

A number of medical problems are possible, as well. These include deep vein thrombosis, pulmonary embolism, infection, pneumonia, cardiac complications, nerve injury, and postoperative swelling. Complications relating to the anesthesia, for example sleep apnea, are also possible.

Anesthesia, as well as pain medication that works on the central nervous system can depress the muscles that open up the pharynx, which is a structure through which air passes during breathing. This very serious condition may add to the breathing problems associated with obesity. It may even be fatal.

Hypoxia-hypoventilation may also hinder your ability to breathe; it is present in 10% of morbidly obese people and may result in the need for additional oxygen treatment during or after the surgery.

Positioning for the procedure is yet another potential danger. When a morbidly obese person is on the surgery table, it can come down to a choice between reaching the surgery site or making another medical condition worse. For example, monitoring blood pressure during the surgery may pose extra challenges for the medical personnel in attendance.

As far as spine related complications are concerned, spinal fusions are a particular concern for surgeons; failed back surgery is one such possibility. The American Academy of Neurosurgeons says that in surgeries done to relieve low back pain, the failure rate for morbidly obese patients is higher than for other patients.

With a list like this, no wonder surgeons tell their obese patients to lose weight prior to the procedure! A 2017 study published in the journal Surgical Neurology International recommends considering major preoperative weight loss strategies — including bariatric surgery — for obese spine patients.

In fact, some surgeons won't agree to operate on morbidly obese patients.

Why Overweight and Obese Patients Are More at Risk

Maneuvering you for diagnostic imaging and navigating surgical implements to the exact right place in your back are not the only potential complications of back surgery. Your other health conditions may put you at a higher risk, as well.

A 2016 review of medical literature published in the Global Spine Journal found that "co-morbid" conditions, i.e., additional diseases that occur in tandem with obesity, likely contribute to high numbers of postoperative complications. It's well known that obesity is associated with metabolic, cardiovascular and other problems such as diabetes and heart disease. The presence of such co-morbid conditions can make your surgery trickier for the healthcare provider to complete without incident.

Not only that, but the study also found that simply being morbidly obese can — in and of itself — raise your risk for post-surgical complications.

Researchers from Thomas Jefferson University concur. According to press materials, they found that the risk for surgery complications increases relative to the degree of obesity. In other words, the higher your body mass index (BMI), the greater the chance that you will experience a problem related to your back surgery.

BMI is a measure of body weight relative to your height. A BMI of 30 or over indicates obesity, and an individual whose BMI is 40 or over is considered morbidly obese.

The Thomas Jefferson researchers found that surgery patients who were of a healthy weight had a 14% complication rate. But in morbidly obese patients, the rate jumped to 36%.

Body Mass Index

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age. 
Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

Benefits of Minimally Invasive Spine Surgery

If your BMI is 30 or above, performing back surgery on you may pose extra legal risks for your healthcare provider. Just the same, many experts recommend that obese patients not be denied back surgery because of their condition.

Minimally invasive spine surgery (MIS) poses fewer complication risks than the traditional type, and may be an option for you.

A 2008 study involving 56 patients could not identify increased risks for complications in MIS patients who were obese or overweight.

For many MIS patients, pain following the procedure is minimal. This may be one reason why MIS patients, in general, can resume work and other activities more quickly than those who have a traditional back surgery. 

The American Academy of Neurosurgeons suggests that reduced disruption on the soft tissues. MIS uses fluoroscopy which allows for very small incisions to be made, as well as better navigation of surgical implements.

A Word From Verywell

Weight loss may be your number one strategy for a successful back surgery. Losing weight prior to your surgery may help reduce some of the issues discussed above such as getting the right diagnosis and surgical procedure, safe positioning, navigating the surgical instrument accurately, keeping you safe while under anesthesia, which includes reducing the risk of sleep apnea, and more.

That said, as with almost any back surgery, trying non-invasive care first may be a good idea. This will likely mean going for physical therapy sessions that emphasize back exercises and core strengthening.

Although being overweight or obese makes sticking with an exercise program more difficult, it may well be in your best interest to put forth the effort. For many people, a properly designed exercise program is the key to avoiding spine surgery altogether. American Family Physician reports that physical therapist–directed home exercise programs for acute back pain may help reduce your need for other medical services, making it a cost-effective treatment route.

If performing the exercises proves too difficult, you might ask your therapist about an aquatic exercise, which tends to be easier on joints.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Al-Dujaili TM, Majer CN, Madhoun TE, Kassis SZ, Saleh AA. Deep venous thrombosis in spine surgery patients: incidence and hematoma formationInt Surg. 2012;97(2):150-154. doi:10.9738/CC71.1

  2. Epstein NE. More risks and complications for elective spine surgery in morbidly obese patientsSurg Neurol Int. 2017;8:66. doi:10.4103/sni.sni_49_17

  3. Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth. 2003;91(6):886-904. doi:10.1093/bja/aeg253

  4. Piper AJ, Grunstein RR. Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med. 2011;183(3):292-8. doi:10.1164/rccm.201008-1280CI   

  5. Obesity and spinal disease. Journal of The Spinal Research Foundation. 4(2):1-62.

  6. Jackson, K., et. al. The effects of obesity on spine surgery: a systematic review of the literature. Global Spine J. 2016;6(4):394-400. doi:10.1055/s-0035-1570750

  7. ScienceDaily. Obesity tied to higher risk of complications in spinal surgery.

  8. Park P, Upadhyaya C, Garton HJ, Foley KT. The impact of minimally invasive spine surgery on perioperative complications in overweight or obese patientsNeurosurgery. 2008;62(3):693-699. doi:10.1227/01.neu.0000317318.33365.f1

  9. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 85(4):343-350.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.