Obesity does not affect the outcome of full-endoscopic lumbar discectomy interlaminar approach
Introduction: Obesity is a risk factor of complications in spine surgery, but its detailed association with full-endoscopic discectomy (FED) is unknown.Methods: Subjects were the patients who underwent FED-interlaminar (IL) approach at the L4/5 or L5/S1 level in our institution between January 2020...
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Published in | Journal of Spine Research Vol. 15; no. 8; pp. 1059 - 1066 |
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Main Authors | , , , |
Format | Journal Article |
Language | Japanese |
Published |
The Japanese Society for Spine Surgery and Related Research
20.08.2024
一般社団法人 日本脊椎脊髄病学会 |
Subjects | |
Online Access | Get full text |
ISSN | 1884-7137 2435-1563 |
DOI | 10.34371/jspineres.2024-0802 |
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Abstract | Introduction: Obesity is a risk factor of complications in spine surgery, but its detailed association with full-endoscopic discectomy (FED) is unknown.Methods: Subjects were the patients who underwent FED-interlaminar (IL) approach at the L4/5 or L5/S1 level in our institution between January 2020 and June 2022. Body mass index (BMI), body surface-disc distance, operative time, facet joint preservation rate, and complication rate were evaluated and compared among three groups: BMI≤20 (group T), 22≤BMI≤28 (group C), and BMI≤30 (group O). Results: A total of 264 patients were included in this study; and 30, 188, and 31 patients were included in group T, C, and O, respectively. There was no significant correlation between BMI or body surface-disc distance and operative time or joint preservation rate. No dural injury, hematoma, or infection occurred in this study. In group O, although diabetes prevalence was higher (35%), complication rate or hospital stay did not increase. In group T, C, and O, there were no significant differences in pain VAS improvement rates (81% vs. 77% vs. 78%), lumbar spine JOA score improvement rates (87% vs. 85% vs. 88%), or revision surgery rates (3% vs. 8% vs. 6%). Conclusions: FED-IL approach was a useful treatment in obese lumbar disc herniation patients. |
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AbstractList | Introduction: Obesity is a risk factor of complications in spine surgery, but its detailed association with full-endoscopic discectomy (FED) is unknown.Methods: Subjects were the patients who underwent FED-interlaminar (IL) approach at the L4/5 or L5/S1 level in our institution between January 2020 and June 2022. Body mass index (BMI), body surface-disc distance, operative time, facet joint preservation rate, and complication rate were evaluated and compared among three groups: BMI≤20 (group T), 22≤BMI≤28 (group C), and BMI≤30 (group O). Results: A total of 264 patients were included in this study; and 30, 188, and 31 patients were included in group T, C, and O, respectively. There was no significant correlation between BMI or body surface-disc distance and operative time or joint preservation rate. No dural injury, hematoma, or infection occurred in this study. In group O, although diabetes prevalence was higher (35%), complication rate or hospital stay did not increase. In group T, C, and O, there were no significant differences in pain VAS improvement rates (81% vs. 77% vs. 78%), lumbar spine JOA score improvement rates (87% vs. 85% vs. 88%), or revision surgery rates (3% vs. 8% vs. 6%). Conclusions: FED-IL approach was a useful treatment in obese lumbar disc herniation patients. Introduction: Obesity is a risk factor of complications in spine surgery, but its detailed association with full-endoscopic discectomy (FED) is unknown.Methods: Subjects were the patients who underwent FED-interlaminar (IL) approach at the L4/5 or L5/S1 level in our institution between January 2020 and June 2022. Body mass index (BMI), body surface-disc distance, operative time, facet joint preservation rate, and complication rate were evaluated and compared among three groups: BMI≤20 (group T), 22≤BMI≤28 (group C), and BMI≤30 (group O). Results: A total of 264 patients were included in this study; and 30, 188, and 31 patients were included in group T, C, and O, respectively. There was no significant correlation between BMI or body surface-disc distance and operative time or joint preservation rate. No dural injury, hematoma, or infection occurred in this study. In group O, although diabetes prevalence was higher (35%), complication rate or hospital stay did not increase. In group T, C, and O, there were no significant differences in pain VAS improvement rates (81% vs. 77% vs. 78%), lumbar spine JOA score improvement rates (87% vs. 85% vs. 88%), or revision surgery rates (3% vs. 8% vs. 6%). Conclusions: FED-IL approach was a useful treatment in obese lumbar disc herniation patients. はじめに:肥満は脊椎手術合併症の危険因子となるが,全内視鏡下椎間板摘出術(full-endoscopic discectomy:FED)との詳細な関係は不明である.方法:2020年1月から2022年6月に当院でFED-interlaminar(IL)法を,L4/5もしくはL5/S1単椎間に施行症例を対象とした.BMI,体表-椎間板距離,手術時間,椎間関節温存率,合併症発生率を評価し,BMI≦20(T群),22≦BMI≦28(C群),BMI≦30(O群)の3群間で比較した.結果:全264症例が研究に含まれ,T群30,C群188,O群31例であった.BMIまたは体表-椎間板距離と,手術時間または椎間関節温存率に有意な相関は無かった.硬膜損傷・血種・感染は発生せず,O群では糖尿病罹患率が35%と高かったが,合併症,在院日数は増加しなかった.T,C,O群の疼痛VAS改善率(81% vs 77%vs 78%),腰椎JOAスコア改善率(87% vs 85% vs 88%)および再手術率(3% vs 8% vs 6%)に有意差は認めなかった.結論:肥満腰椎椎間板ヘルニア患者においてFED-IL法は有用な治療法である. |
Author | Yoneyama, Reiko Endo, Yasuhiro Ohmori, Kazuo Lee, Deokcheol |
Author_FL | 遠藤 康広 李 徳哲 大森 一生 米山 励子 |
Author_FL_xml | – sequence: 1 fullname: 李 徳哲 – sequence: 2 fullname: 大森 一生 – sequence: 3 fullname: 米山 励子 – sequence: 4 fullname: 遠藤 康広 |
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References | 1) Knai C, Suhrcke M, Lobstein T: Obesity in eastern Europe: an overview of its health and economic implications. Econ Hum Biol. 2007; 5: 392-408 10) 米山励子, 大森一生, 松繁 治: Full-endoscopic discectomy導入初期と現在のラーニングカーブの比較検討. J Spine Res. 2021; 12: 1030-1034 4) Bae JS, Lee SH: Transforaminal full-endoscopic lumbar discectomy in obese patients. Int J Spine Surg. 2016; 10: 18. doi: 10.14444/3018 7) McGuire KJ, Khaleel MA, Rihn JA, et al: The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976). 2014; 39: 1975-1980 8) Bergquist J, Greil ME, Khalsa SSS, et al: Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression. Eur Spine J. 2023; 32: 2748-2754 2) Patel N, Bagan B, Vadera S, et al: Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007; 6: 291-297 5) Varshneya K, Wadhwa H, Stienen MN, et al: Obesity in patients undergoing lumbar degenerative surgery-a retrospective cohort study of postoperative outcomes. Spine (Phila Pa 1976). 2021; 46: 1191-1196 9) Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, et al: Full-Endoscopic lumbar discectomy approach selection: a systematic review and proposed algorithm. Spine (Phila Pa 1976). 2023; 48: 534-544 3) Carroll AH, Dowlati E, Molina E, et al: Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries. J Neurosurg Spine. 2021; 35: 460-470 6) Sharma A, Shakya A, Singh V, et al: Does a high BMI affect the outcome of minimally invasive TLIF? A retrospective study of 207 patients. Eur Spine J. 2021; 30: 3746-3754 11) 大森一生, 小野孝一郎, 吉原 潔: PED経椎弓間法 (IL法) 導入後の手技別ラーニングカーブに関する検討. J Spine Res. 2014; 5: 1224-1228 12) 米山励子, 大森一生, 松繁 治: LOVE法未経験術者のFED法のラーニングカーブ. J Spine Res. 2022; 13: 1061-1065 |
References_xml | – reference: 3) Carroll AH, Dowlati E, Molina E, et al: Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries. J Neurosurg Spine. 2021; 35: 460-470 – reference: 10) 米山励子, 大森一生, 松繁 治: Full-endoscopic discectomy導入初期と現在のラーニングカーブの比較検討. J Spine Res. 2021; 12: 1030-1034 – reference: 1) Knai C, Suhrcke M, Lobstein T: Obesity in eastern Europe: an overview of its health and economic implications. Econ Hum Biol. 2007; 5: 392-408 – reference: 12) 米山励子, 大森一生, 松繁 治: LOVE法未経験術者のFED法のラーニングカーブ. J Spine Res. 2022; 13: 1061-1065 – reference: 7) McGuire KJ, Khaleel MA, Rihn JA, et al: The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976). 2014; 39: 1975-1980 – reference: 2) Patel N, Bagan B, Vadera S, et al: Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007; 6: 291-297 – reference: 5) Varshneya K, Wadhwa H, Stienen MN, et al: Obesity in patients undergoing lumbar degenerative surgery-a retrospective cohort study of postoperative outcomes. Spine (Phila Pa 1976). 2021; 46: 1191-1196 – reference: 8) Bergquist J, Greil ME, Khalsa SSS, et al: Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression. Eur Spine J. 2023; 32: 2748-2754 – reference: 4) Bae JS, Lee SH: Transforaminal full-endoscopic lumbar discectomy in obese patients. Int J Spine Surg. 2016; 10: 18. doi: 10.14444/3018 – reference: 11) 大森一生, 小野孝一郎, 吉原 潔: PED経椎弓間法 (IL法) 導入後の手技別ラーニングカーブに関する検討. J Spine Res. 2014; 5: 1224-1228 – reference: 6) Sharma A, Shakya A, Singh V, et al: Does a high BMI affect the outcome of minimally invasive TLIF? A retrospective study of 207 patients. Eur Spine J. 2021; 30: 3746-3754 – reference: 9) Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, et al: Full-Endoscopic lumbar discectomy approach selection: a systematic review and proposed algorithm. Spine (Phila Pa 1976). 2023; 48: 534-544 |
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SubjectTerms | full-endoscopic discectomy obesity postoperative complication 全内視鏡下椎間板切除術 肥満 術後合併症 |
Title | Obesity does not affect the outcome of full-endoscopic lumbar discectomy interlaminar approach |
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