• Matthew Smuck, Patricia Zheng, Timothy Chong, Ming-Chih Kao, and Michael E Geisser.
• Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA. msmuck@stanford.edu
• PM R. 2013 Apr 1;5(4):291-6; quiz 296.

BackgroundThe impact of patient body mass index (BMI) on image-guided spine interventions remains unknown. Higher BMI is known to complicate the acquisition of radiographic images. Therefore it can be hypothesized that the patient's body habitus can influence the delivery of a spinal injection.ObjectiveTo quantify the impact of patient BMI on the length of fluoroscopy and procedure times during spine interventions.DesignSecondary analysis of 2 prospective observational studies.SettingAll injections were performed in an outpatient university setting.ParticipantsA total of 209 patients in whom spine injections were performed (99 women), with a mean age of 54.6 years.MethodsThe fluoroscopy times for 202 participants and total procedure times for 137 participants were recorded. Additional participant characteristics, including age, gender, BMI, and actual procedures performed, also were collected. Analysis of covariance and linear and nonlinear model analysis were performed to assess the effect of BMI on fluoroscopy and procedure times.Main Outcome MeasurementsFluoroscopy time and procedure duration times.ResultsParticipants had a mean age of 54.6 years, 51% were men, and 77% (n = 155) were overweight (BMI ≥25). Participants received the following interventions: 40 zygapophyseal joint injections, 33 medial branch nerve blocks, 113 transforaminal epidural injections, and 16 combined zygapophyseal joint injections and epidural injections. Gender, procedure number, and procedure type did not differ between groups. The overweight group demonstrated a 30% increase in mean fluoroscopy time and a 35% increase in mean procedure time. Controlling for other variables, we found that differences in fluoroscopy time and procedure time were significant (P = .032 and P = .031, respectively) between the 2 groups.ConclusionsSignificantly prolonged procedure time and fluoroscopy time in overweight patients increase the risks associated with spine interventions, not only to the patients but also to the operating room staff exposed to ionizing radiation.Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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