The effects of metabolic and bariatric surgery on spinal alignment, radiological, and clinical outcomes in morbidly obese patients with LBP: a systematic review and meta-analysis.

BACKGROUND: Metabolic and bariatric surgery (MBS), employing mechanisms like malabsorption, volume restriction, and metabolic changes via the gastrointestinal tract, is the most effective long-term treatment for obesity and related metabolic disorders. Obesity affects over one-third of the U.S. population and is closely linked to low back pain (LBP) due to increased spinal loading and altered alignment. Weight loss following surgery may alleviate LBP symptoms and improve spinal health by reducing mechanical stress. PURPOSE: This systematic review and meta-analysis evaluated the impact of MBS on LBP, quality of life, and spinal pathologies in morbidly obese patients, focusing on improvements in spinal alignment, intervertebral disc health, and related outcomes. STUDY DESIGN/SETTING: Systematic review and meta-analysis conducted according to PRISMA guidelines and the PICOS framework. PATIENT SAMPLE: Adult morbidly obese patients (body mass index ≥40 kg/m²) with LBP who underwent MBS (sleeve gastrectomy, Roux-en-Y gastric bypass, or gastric banding) were included. OUTCOME MEASURES: Primary outcomes included changes in LBP (measured by visual analog scale [VAS]), quality of life (measured by SF-36), and spinal health (evaluated by MRI or X-rays). METHODS: The review adhered to PRISMA guidelines and followed the PICOS framework. Eligible studies included adult morbidly obese patients with LBP who underwent MBS. Studies compared outcomes between surgical and nonsurgical interventions. Data were extracted from prospective, cross-sectional, and retrospective studies published between 2000 and 2025. A meta-analysis was conducted using RevMan 5.4 software, with standardized mean differences and risk ratios. RESULTS: A total of 13 studies met inclusion criteria, representing 390 participants. MBS significantly reduced LBP, with presurgery VAS scores ranging from 6.8 to 7.6 and postsurgery scores decreasing to 3.0 to 4.1. Quality of life, assessed through the SF-36 and Oswestry Disability Index, showed substantial improvements, particularly in physical function and daily activities. Spinal imaging studies reported increased intervertebral disc height and improved lumbar lordosis postoperatively. However, changes in spinopelvic alignment were inconsistent across studies. CONCLUSIONS: MBS significantly reduces LBP severity, improves quality of life, and may contribute to spinal health improvements in morbidly obese patients. Additionally, weight loss increases disc height and enhances lumbar lordosis. These improvements are primarily attributed to weight loss and its alleviating effects on mechanical stress on the spine. Future studies with longer follow-up and standardized imaging assessments are needed to further elucidate its impact on spinal biomechanics.

Duke Scholars

Author Alfonso Torquati Surgery, Minimally Invasive Surgery