Adogwa Owoicho, Farber S Harrison, Fatemi Parastou, Desai Rupen, Elsamadicy Aladine, Cheng Joseph, Bagley Carlos, Gottfried Oren, Isaacs Robert E
Division of Neurosurgery, Duke University Medical Center, Duke South, Blue Zone Room 4528, Durham, NC 27710, USA.
Division of Neurosurgery, Duke University Medical Center, Duke South, Blue Zone Room 4528, Durham, NC 27710, USA.
J Clin Neurosci. 2016 Mar;25:54-7. doi: 10.1016/j.jocn.2015.05.056. Epub 2015 Nov 6.
Obese patients undergoing lumbar spinal fusion surgery are a challenge to the operating surgeon. Direct lateral interbody fusion (DLIF) has been performed for degenerative disease of the lumbar spine with good outcomes; nevertheless, how obese patients fare compared to non-obese patients after DLIF remains unknown. The primary aim of this study is to compare rates of postoperative complications and long-term outcomes between obese and non-obese patients undergoing DLIF. Sixty-three patients (obese: 29, non-obese: 34) undergoing index DLIF for degenerative disease of the spine between 2010 and 2012 at our institution were retrospectively enrolled. We analyzed data on demographics, postoperative complications, back and leg pain, and functional disability over 2 years. Patients completed the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain numerical rating scores before surgery, then at 12 and 24 months after surgery. Outcomes and complication rates were compared between the cohorts. The cohorts were similar at baseline. Postoperative complications rates were similar between obese and non-obese patients. There was no statistically significant difference in the incidence of durotomy (p=0.91), anterior thigh numbness (p=0.60), cerebrospinal fluid leak (p=0.91), postoperative infection (p=0.37), or bleeding requiring transfusion (p=0.16). No patient experienced a nerve injury or psoas hematoma. Both cohorts had similar 2 year improvement in VAS for back pain, leg pain, and ODI. Our study demonstrates that obese and non-obese patients undergoing DLIF have similar complication profiles; hence, a patient's weight should not be a contraindication to DLIF.
接受腰椎融合手术的肥胖患者对手术医生来说是一项挑战。直接外侧椎间融合术（DLIF）已用于治疗腰椎退行性疾病，效果良好；然而，与非肥胖患者相比，肥胖患者在接受DLIF后的情况仍不清楚。本研究的主要目的是比较接受DLIF的肥胖患者和非肥胖患者术后并发症发生率及长期疗效。回顾性纳入了2010年至2012年在我院因脊柱退行性疾病接受初次DLIF手术的63例患者（肥胖患者29例，非肥胖患者34例）。我们分析了患者的人口统计学数据、术后并发症、腰腿痛及2年以上的功能障碍情况。患者在手术前、术后12个月和24个月完成Oswestry功能障碍指数（ODI）及视觉模拟量表（VAS）腰腿痛数字评分。比较两组患者的疗效和并发症发生率。两组患者基线情况相似。肥胖患者和非肥胖患者术后并发症发生率相似。硬膜切开术（p=0.91）、大腿前侧麻木（p=0.60）、脑脊液漏（p=0.91）、术后感染（p=0.37）或需要输血的出血（p=0.16）的发生率在两组间无统计学显著差异。没有患者发生神经损伤或腰大肌血肿。两组患者在腰背痛、腿痛的VAS评分及ODI评分方面在2年内的改善情况相似。我们的研究表明，接受DLIF的肥胖患者和非肥胖患者并发症情况相似；因此，患者体重不应成为DLIF手术的禁忌证。
