Impact of Bariatric Surgery on Intervertebral Disc Pathology and Low Back Pain

Abstract

Background: Obesity is a growing global health concern associated with a range of comorbidities, including chronic low back pain (LBP) and intervertebral disc (IVD) degeneration. Bariatric surgery (BS) is a well-established intervention for significant weight reduction; however, its impact on spinal health, particularly LBP and disc pathology, remains inconclusive. This study aimed to assess the effects of bariatric surgery on intervertebral disc height and chronic low back pain using both imaging and clinical outcome measures.

Methods: This retrospective cohort study analyzed 31 obese patients (BMI ≥30 kg/m²) with chronic LBP who underwent bariatric surgery at a single tertiary hospital. Clinical outcomes, including BMI, Visual Analog Scale (VAS) for pain, Disability Rating Index (DRI), and Roland-Morris Disability Questionnaire (RMD), were assessed before and at least 3 months post-surgery. MRI scans were evaluated using the modified Pfirrmann grading system to assess disc degeneration. Statistical analyses included paired t-tests and Wilcoxon signed-rank tests.

Results: The study cohort had a mean age of 42.8 years, with 87% of participants being female. Postoperative BMI was significantly reduced (p<0.001), confirming effective weight loss. However, there were no statistically significant improvements in VAS, DRI, or RMD scores, nor in Pfirrmann grades at any lumbar level (p>0.05). A significant association was found between older age (>40 years) and higher postoperative RMD scores (p=0.010).

Conclusion: While bariatric surgery effectively reduces BMI, it does not appear to confer statistically significant short- to mid-term benefits for LBP or IVD degeneration. These findings suggest that weight loss alone may be insufficient to address spinal pathology and highlight the need for integrated, multimodal management strategies. Further long-term prospective studies are needed to evaluate the potential delayed effects of weight reduction on spinal health.