脊椎ジャーナル

Minimally Invasive Surgery for Lumbar Decompression in Obese Patients

Abstract

Zachary A. Smith, Alexander T. Nixon, Cort D Lawton, Nader S Dahdaleh, Albert P Wong, Najib El Tecle, Melody Hrubes, Jon Park and Richard G Fessler

Background: Micro endoscopic decompression of stenosis and micro endoscopic discectomy has been shown to be safe and effective. Minimally invasive techniques are associated with decreased soft tissue injury, less pain, and quicker patient recovery. The obese population can pose unique peri-operative challenges. We explored the role of obesity on self-reported outcomes, blood loss, operative time, length of stay, and complications following minimally invasive lumbar decompression.

Methods: A retrospective review of outcomes on 60 obese patients (BMI ≥30 kg/m2) who underwent minimally invasive micro endoscopic decompression of stenosis or micro endoscopic discectomy, compared to 51 normalweight patients (BMI 18.5 kg/m2-24.9 kg/m2), undergoing the same procedures. Outcomes analyzed included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI).

Results: In 51 normal-weight patients, the mean age was 55.0 years and average BMI was 23.2 ± 0.4 kg/m2. In 60 obese patients, the mean age was 58.0 years and average BMI 34.2 ± 0.6 kg/m2. Mean operative time was 99 ± 4 minutes, and LOS was 9.8 ± 2.7 hours for the normal-weight group. For obese patients, the mean operative time was significantly longer with 117 ± 5 minutes; LOS was 16.1 ± 5.1 hours. BMI significantly correlated with operative time (p= 0.002). Obese patients had a statistically significant (p=0.04) increased estimated blood loss (26.7 cc) compared to normal-weight patients (19.5 cc). Improvements in VAS-back, VAS-leg, and ODI were seen within each cohort. There were no statistically significant differences between the obese and normal groups at the last follow-up. The obese group had more complications (8.33%) compared to normal controls (3.92%), but was not statistically significant.

Conclusion: Microendscopic decompression of stenosis and micro endoscopic discectomy are effective surgical options for the obese population. Obesity did not have an impact on self-reported outcomes or length of stay. Obesity was associated with an increase in average operative time, estimated blood loss, and subsequent return to surgery