Body Mass Index and severity of lumbar degenerative disc disease in adult patients using Oswestry Disability Index: any correlation?

Abstract

Background: More than 90% of people will experience an episode of debilitating Low Back Pain (LBP) at some point in their lifetime. Lumbar Degenerative Disc Disease (LDDD) is the commonest cause of LBP globally in individuals aged 40 years and above. Body Mass Index (BMI) may be directly related to LDDD pathogenesis, progression, severity of symptom manifestation, and response to treatment.

Objectives: The aim of this study was to determine the relationships between BMI and symptoms severity of LDDD in adult patients using Oswestry Disability Index (ODI); to determine the relationship between BMI and the clinical severity of LDDDs, and to determine the relationship between BMI and ODI in these patients.

Methodology: All adult patients with signs and symptoms of LDDD presenting at clinic or emergency room were consecutively recruited and studied in two government tertiary hospitals in the North West and South West of Nigeria. The weight, height, symptomatology and ODI preformats were assessed for each patient. The information was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. The statistical significance was set at P< 0.05. The chi-square tests were used to determine the relationships of BMI with the severity of symptoms and ODI in the studied patients.

Results: The study involved 344 patients with male to female ratio of 1:1.6 and mean age of 59.8 years. The patients with normal range of BMI and elevated BMI accounted for 32% (110 patients) and 68% (234 patients) respectively. The study showed 73% of the participants with severe forms of disability while 27% of them had mild to moderate disability. The durations of symptoms varied from 1 to 15 years with the mean symptoms duration of 5.63 years. All the patients presented with varied and multiple symptoms. Altered sensation (paraesthesia) was found in 99.4% of them. The involved levels of lumbar spine on radiographs were L5/S1 (40.4%), T12/L1 (18.6%), L4/L5 (21.3%), L1/L2 (11.2%), L2/L3 (3.3%), L3/L4 (2.7%) and T12/L1 to L5/S1 (2.5%). There was a significant relationship between clinical symptoms and patients BMI on Chi-Square Tests (p < 0.05). The BMI also showed a significant relationship with ODI (p value = 0.001) while in symptoms and ODI (p value < 0.05).

Conclusions: This study showed that there was a statistically significant (P < 0.05) relationship between BMI and clinical severity of LDDD including severity of Oswestry ODI with worsened symptoms among individuals with elevated BMI when compared to those with normal range of BMI.

Keywords: Body Mass Index, Lumbar Degenerative Disc Disease, Clinical severity