Background: The adverse effect of obesity on spine surgery outcomes has been postulated and reported multiple times but with some controversy. The impact of general anesthesia on patients with multiple medical comorbidities and the prolonged retraction times associated with thicker soft tissue havebeenimplicated as potential factors in the higher complication rates seen in this population.
Objectives: Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to obese patients that does not require general anesthesia and does not necessitate additional retraction due to additional thicker soft tissue. The purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in obese patients with single level lumbar disc herniations and lumbar radiculopathy.
Methods: After Institutional Review Board Approval, charts from 82 consecutive patients with BMIs of at least 30 kg/m2 who had undergone single level endoscopic lumbar discectomies and foraminotomies were retrospectively identified and categorized according to BMI: Class I obesity, BMI 30.0-34.9 kg/m2; Class II obesity, BMI 35.0-39.9 kg/m2; or Class III obesity, BMI ≥40.0 kg/m2. Patients aged 40 and older (average age 61.8, 40% female) with complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed.
Results: The average pain relief 1 year postoperatively was reported to be 68.4% for Class I, 66.1% for Class II, and 43.5% for Class III. The average pre-operative VAS scores were 8.8 for Class I, 9.2 for Class II, and 9.0 for Class III, all as indicated in our questionnaire as describing severe and constant pain. The average 1 year postoperative VAS scores were 2.6 for Class I, 3.0 for Class II, and 3.2 for Class III, indicated in our questionnaire as mild and intermittent pain. There were no infections or other complications reported and the reherniation rate for the 1 year was 7.5% in Class I, 12.5% in Class II, and 0% in Class III.
Conclusion: Endoscopic discectomy is a safe and effective alternative to open back surgery. The1 year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the obese spine patient that has a low complication rate, avoids general anesthesia, is performed in the lateral position, and is outpatient might be worth studying in a prospective, longer term way.
آدرس مطب : تهران ، خیابان آفریقا ، چهارراه جهان کودک ، نبش کوچه صانعی ، برج امیر پرویز ، طبقه دوم ، واحد 23
تلفن : 88878411 - 021