Patients who find themselves in your position often wonder if this kind of decision is really justified. Are patients really at increased risk for problems during and after surgery just because they are obese? Is there any evidence to support this kind of guideline?
In fact, there are many factors to consider. For example, there can be difficulties getting a clear airway to allow the patient to breathe while being anesthetized. Folds of fat and flabby soft tissue collapse against the airway preventing intubation (placement of a breathing tube down the trachea).
It can be equally difficult to gain access to a blood vessel to start an intravenous (IV) line. Positioning the patient can be a tremendous challenge. For example, pressure on the belly can cause greater blood loss. Whenever possible, the patient is placed in such a way that the abdomen hangs free. Even more serious is the fact that studies have confirmed the link between obesity and the increased incidence of complications (including death) during and after the surgery.
There was a recent study done at the Henry Ford Hospital in Detroit showing that obese patients who had lumbar fusion surgery really didn’t lose weight after the operation. One caveat to the study was the fact that no effort was made to help patients lose weight. They were not counseled about weight loss or enrolled in an exercise program following the surgery.
You may still want to pursue the surgical approach in order to reduce your pain and improve your quality of life. It may be possible to find a surgeon willing to take high-risk patients. It will be important for you to fully understand the possible risks for yourself in terms of complications that can occur during and after the surgery.
One other option is to have bariatric surgery (e.g., stomach banding or gastric bypass) first. Lose weight. Then reconsider back surgery. You should be aware that low back pain and chronic depression are risk factors for a poor outcome after bariatric surgery as well. Some surgeons will not consider you a good candidate for bariatric surgery because of your history of low back pain.