JAAOS - 2026-05-22 - Journal Article
Impact of Obesity, Sarcopenia, and Nutritional Status on Spine Surgery Patients.
Daniels AH, Kim J, Nassar JE, Diebo BG
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Key Takeaway
Sarcopenic obesity and central adiposity independently predict wound complications, mechanical failure, and delayed recovery in spine surgery patients beyond what BMI alone captures.
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Summary
This narrative review examines the impact of obesity phenotypes, sarcopenic obesity, and nutritional deficiencies on spine surgery outcomes, arguing that BMI alone is an inadequate risk stratification tool. The authors synthesize evidence on central adiposity, muscle quality, and micronutrient deficits (vitamin D, iron, protein) as independent drivers of wound complications, fusion failure, and prolonged recovery. A preoperative optimization framework incorporating dietary counseling, resistance prehabilitation, and GLP-1 receptor agonists is proposed.
Key Limitation
As a narrative review without systematic search criteria or meta-analytic synthesis, the evidence hierarchy supporting specific optimization interventions (e.g., GLP-1 agonists, prehabilitation protocols) and their effect sizes on fusion rates or complication reduction remains undefined.
Original Abstract
Obesity, sarcopenia, and malnutrition are increasingly recognized as key determinants of outcomes in spine surgery. Reliance on body mass index alone does not capture variations in fat distribution, muscle quality, or nutritional status, each of which affects perioperative risk. Central adiposity and sarcopenic obesity are independent predictors of wound complications, mechanical failure, and delayed recovery. Nutritional deficiencies in obese and postbariatric patients, including low levels of vitamin D, iron, and protein, can further impair bone healing and fusion. Emerging evidence supports structured preoperative optimization through dietary counseling, resistance-based prehabilitation, and coordinated multidisciplinary management. Glucagon-like peptide-1 receptor agonists represent a promising pharmacologic option that improves metabolic control and facilitates weight reduction without the malabsorption associated with bariatric surgery. This review summarizes current understanding of obesity phenotypes, sarcopenic obesity, and nutritional deficiency in spine patients and presents a practical framework for preoperative optimization to reduce complications, enhance fusion rates, and improve long-term surgical outcomes.