Influence of Body Mass Index on Surgical and Patient Outcomes for Cervical Spine Surgery

Anant Naik, Christina Moawad, James S. Harrop, Sanjay Dhawan, Samuel W. Cramer, Paul M. Arnold

Research output: Contribution to journalArticlepeer-review


Study Design: Secondary analysis of prospectively collected registry. Objective: We aim to investigate the effects of body mass index (BMI) on postsurgical cervical spine surgery outcomes and identify a potential substratification of obesity with worse outcomes. Summary of Background Data: The impact of BMI on cervical spine surgery is unknown, with controversial outcomes for patients high and low BMI. Methods: The cervical spine Quality Outcomes Database was queried for a total of 10,381 patients who underwent single-stage cervical spine surgery. Patients were substratified into 6 groups based on BMI. Surgical outcomes, complications, hospitalization outcomes, and patient-reported outcomes for each cohort, including modified Japanese Orthopedic Association Score, Numeric Rating Scale arm pain, Numeric Rating Scale neck pain, Neck Disability Index, and EuroQol Health Survey, were assessed. Univariate analysis was performed for 3- and 12-month follow-up after surgical intervention. Results: Obese patients (class I, II, and III) requiring spine surgery were statistically younger than nonobese patients and had higher rates of diabetes compared with normal BMI patients. The surgical length was found to be longer for overweight and all classes of obese patients (P < 0.01). Class III obese patients had higher odds of postoperative complications. Patients with class II and III obesity had lower odds of achieving optimal modified Japanese Orthopedic Association Score at 3 months [OR = 0.8 (0.67–0.94), P < 0.01, OR = 0.68 (0.56–0.82), P < 0.001, respectively] and 12 months [OR = 0.82 (0.68–0.98), P = 0.03, OR = 0.79 (0.64–0.98), P = 0.03, respectively]. Conclusions: This study investigates the relationship between substratified BMI and postoperative outcomes of cervical spine surgery. Class II and III obese patients have substantially greater risk factors and poor outcomes postoperatively. In addition, low BMI also presents unique challenges for patients. Further research is needed for comprehensive analysis on outcomes of cervical spine surgery after correcting BMI.

Original languageEnglish (US)
Pages (from-to)E73-E81
JournalClinical spine surgery
Issue number2
StatePublished - Mar 1 2024
Externally publishedYes


  • body mass index
  • cervical spine surgery
  • decompression
  • fusion
  • modifiable disease factors
  • obesity
  • patient-reported outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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