Rapid Weight Loss Considerations for a Patient with Class 3 Obesity with Spinal Cord Compression and Cancer in the Post-Operative Period

Case Diagnosis: 44-year-old male with solitary plasmacytoma causing spinal cord compression.

Case Description or Program Description: 44-year-old male with class 3 obesity (BMI 70, weight 543 pounds) was admitted with progressive urinary incontinence and leg weakness over two months, causing multiple falls and right fibular fracture. CT scan demonstrated a lytic lesion in the T8 vertebral body, causing cord compression. His weight precluded MRI or needle biopsy so an open biopsy, decompression, and T5-T10 fusion was performed, requiring complex closure by plastic surgery. He was diagnosed with solitary plasmacytoma and local radiation was recommended. Due to weight restrictions (maximum 500 pounds), he was ineligible for radiation. He was admitted to the inpatient rehabilitation facility (IRF) for T3 ASIA D spinal cord injury.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: In IRF, patient required specialized bariatric equipment and ultimately discharged at wheelchair level, requiring supervision for transfers. Semaglutide 2 mg weekly was started in IRF to aid in weight loss. Remarkably, he lost 47 pounds in approximately one month, making him eligible for radiation therapy.

Discussion (relevance): Severe obesity created barriers to timely diagnostics, treatment, and functional goals for this patient. GLP-1 agonists are considered safe and effective for facilitating rapid weight loss. However, concerns remain regarding nutritional status of these patients during and after treatment. Weight and weight loss can impact cancer outcomes, and nutritional deficiencies can increase post-operative complications. Our poster discusses the risk-benefit considerations of weight loss and potential impacts for each of his comorbidities, as well as patient education points.

Conclusions: GLP-1 receptor agonists show promise in facilitating weight loss to improve medical and functional outcomes. However, a multidisciplinary approach is essential to balance the benefits and risks of weight loss interventions. Further research is needed to optimize rehabilitation strategies for obese patients with SCI and cancer. Patient education and counseling are essential for ensuring successful outcomes.