Does Greater Body Mass Index Increase the Risk for Revision Procedures Following a Single-Level Minimally Invasive Lumbar Discectomy?
Bibliographic record
Abstract
STUDY DESIGN: Retrospective analysis of a prospectively maintained surgical registry. OBJECTIVE: To examine the association between body mass index (BMI) and the risk for undergoing a revision procedure following a single-level minimally invasive (MIS) lumbar discectomy (LD). SUMMARY OF BACKGROUND DATA: Studies conflict as to whether greater BMI contributes to recurrent herniation and the need for revision procedures following LD. Patients and surgeons would benefit from knowing whether greater BMI is a risk factor to guide the decision whether to pursue an operative versus non-operative treatment. METHODS: Patients undergoing a single-level MIS LD were retrospectively identified in our institution's prospectively maintained surgical registry. BMI was categorized as normal weight (<25 kg/m), overweight (25-30 kg/m), obese (30-40 kg/m), or morbidly obese (≥40 kg/m). Multivariate analysis was used to test for association with undergoing a revision procedure during the first 2 postoperative years. The model was demographics, comorbidities, and operative level. RESULTS: A total of 226 patients were identified. Of these, 56 (24.8%) were normal weight, 80 (35.4%) were overweight, 66 (29.2%) were obese, and 24 (10.6%) were morbidly obese. A total of 23 patients (10.2%) underwent a revision procedure in the first 2 postoperative years. The 2-year risk for revision procedure was 1.8% for normal weight patients, 12.5% for overweight patients, 9.1% for obese patients, and 25.0% for morbidly obese patients. In the multivariate-adjusted analysis model, BMI category was independently associated with undergoing a revision procedure (P = 0.038). CONCLUSION: These findings indicate that greater BMI is an independent risk factor for undergoing a revision procedure following a LD. These findings conflict with recent studies that have found no difference between obese and non-obese patients in regards to risk for recurrent herniation and/or revision procedures. Patients with greater BMI undergoing LD should be informed they could have an elevated risk for revision procedures. LEVEL OF EVIDENCE: 4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".