Krüger Marie T, Naseri Yashar, Hohenhaus Marc, Hubbe Ulrich, Scholz Christoph, Klingler Jan-Helge
Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Clin Neurol Neurosurg. 2019 Mar;178:82-85. doi: 10.1016/j.clineuro.2019.02.004. Epub 2019 Feb 4.
The negative effects of obesity on the health and quality of life of those afflicted has become an important public concern. Previous studies have shown an association between obesity and higher rates of complications and unfavorable outcomes following spine surgery. This study is to identify peri- and postoperative complication rates as well as short-term and long-term outcomes in morbidly obese patients who underwent minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in comparison to age-matched normal-weight patients.
We retrospectively reviewed medical records for all adult patients with a body mass index (BMI) ≥40 kg/m who underwent 1- to 2-level MIS TLIF for degenerative disease between February 2009 and February 2014 at a single institution and compared them to age-matched normal-weight patients (BMI 20-25 kg/m). Duration of operation, length of hospital stay, use of analgesics, minor and major complications (infections and re-operations) as well as postoperative pain reduction within 30 days of surgery were recorded. Furthermore, we collected long-term follow-up data (>1 year) regarding complications and pain reduction.
We identified 14 patients with a BMI ≥ 40 kg/m (mean, 43.2 kg/m) who underwent MIS TLIF. Both groups showed comparable complication rates and clinical results in the short term (<30 days). Compared to 14 normal-weight patients (mean, 23.5 kg/m), morbidly obese patients had significantly longer duration of single level operations (235 vs. 168 min; P = 0.0264) as well as a longer average length of stay (7.7 vs. 5.4; P = 0.0308) and a numerically higher need for analgesics (WHO level; P = 0.0828). In the long-term follow-up of the available 13 patients, the morbidly obese group had a higher complication rate (2/7 morbidly obese vs. 0/6 normal weight), a greater need for analgesics and a higher score in the VAS for lower back pain (6.0 vs. 2.4).
MIS TLIF is technically feasible in morbidly obese patients with no evidence of higher complication rates among this demographic compared to normal-weight individuals when followed-up in the short-term (<30 days); however, available long-term follow-up data suggest a higher complication rate, greater need for analgesics and a much lower reduction of lower back pain in the morbidly obese group.
肥胖对患者健康和生活质量的负面影响已成为一个重要的公共问题。先前的研究表明，肥胖与脊柱手术后更高的并发症发生率和不良预后之间存在关联。本研究旨在确定与年龄匹配的正常体重患者相比，接受微创经椎间孔腰椎椎间融合术（MIS TLIF）的病态肥胖患者的围手术期和术后并发症发生率以及短期和长期预后。
我们回顾性分析了2009年2月至2014年2月在单一机构接受1至2节段MIS TLIF治疗退行性疾病的所有体重指数（BMI）≥40 kg/m²的成年患者的病历，并将其与年龄匹配的正常体重患者（BMI 20 - 25 kg/m²）进行比较。记录手术时间、住院时间、镇痛药使用情况、轻微和严重并发症（感染和再次手术）以及术后30天内的疼痛减轻情况。此外，我们收集了关于并发症和疼痛减轻的长期随访数据（>1年）。
我们确定了14例BMI≥40 kg/m²（平均43.2 kg/m²）接受MIS TLIF的患者。两组在短期内（<30天）显示出可比的并发症发生率和临床结果。与14例正常体重患者（平均23.5 kg/m²）相比，病态肥胖患者单节段手术时间明显更长（235对168分钟；P = 0.0264），平均住院时间更长（7.7对5.4；P = 0.0308），镇痛药需求在数值上更高（WHO分级；P = 0.0828）。在对13例可用患者的长期随访中，病态肥胖组的并发症发生率更高（病态肥胖组2/7对正常体重组0/6），镇痛药需求更大，下腰痛视觉模拟评分（VAS）更高（6.0对2.4）。
对于病态肥胖患者，MIS TLIF在技术上是可行的，短期内（<30天）随访时，该人群与正常体重个体相比没有更高并发症发生率的证据；然而，现有的长期随访数据表明，病态肥胖组的并发症发生率更高，镇痛药需求更大，下腰痛减轻程度更低。
