Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2021 Mar;82(2):147-153. doi: 10.1055/s-0040-1718758. Epub 2020 Dec 22.
Percutaneous pedicle screw fixation in obese patients remains a surgical challenge. We aimed to compare patient-reported outcomes and complication rates between obese and nonobese patients who were treated by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
The authors retrospectively reviewed patients who underwent MIS-TLIF at a single institution between 2011 and 2014. Patients were classified as obese (body mass index [BMI] ≥30 kg/m) or nonobese (BMI < 30 kg/m), according to their BMI. Outcomes assessed were complications, numerical rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) scores.
The final study group consisted of 71 patients, 24 obese (33.8%, 34.8 ± 3.8 kg/m) and 47 nonobese (66.2%, 25.4 ± 2.9 kg/m). Instrumentation failures (13.6 vs. 17.0%), dural tears (17.2 vs. 4.0%), and revision rates (16.7 vs. 19.1%) were similar between both groups ( > 0.05). Perioperative improvements in back pain (4.3 vs. 5.4, = 0.07), leg pain (3.8 vs. 4.2, = 0.6), and ODI (13.3 vs. 22.5, = 0.5) were comparable among the groups and persisted at long-term follow-up. Obese patients had worse postoperative physical component SF-36 scores than nonobese patients (36.4 vs. 42.7, = 0.03), while the mental component scores were not statistically different ( = 0.09).
Obese patients can achieve similar improvement of the pain intensity and functional status even at long-term follow-up. In patients with appropriate surgical indications, obesity should not be considered a contraindication for MIS-TLIF surgery.
经皮椎弓根螺钉固定在肥胖患者中仍然是一项具有挑战性的手术。我们旨在比较微创经椎间孔腰椎体间融合术（MIS-TLIF）治疗的肥胖患者和非肥胖患者的患者报告结果和并发症发生率。
作者回顾性分析了 2011 年至 2014 年期间在一家机构接受 MIS-TLIF 的患者。根据 BMI 将患者分为肥胖（BMI≥30kg/m）或非肥胖（BMI<30kg/m）。评估的结果包括并发症、腰背腿痛的数字评分量表（NRS）评分、Oswestry 残疾指数（ODI）和 36 项简明健康调查量表（SF-36）评分。
最终的研究组包括 71 例患者，24 例肥胖（33.8%，34.8±3.8kg/m）和 47 例非肥胖（66.2%，25.4±2.9kg/m）。两组之间器械失败率（13.6%比 17.0%）、硬脊膜撕裂率（17.2%比 4.0%）和翻修率（16.7%比 19.1%）相似（ > 0.05）。两组患者的腰背疼痛（4.3 比 5.4， = 0.07）、下肢疼痛（3.8 比 4.2， = 0.6）和 ODI（13.3 比 22.5， = 0.5）的围手术期改善情况相似，并且在长期随访中仍然存在。肥胖患者的术后物理成分 SF-36 评分低于非肥胖患者（36.4 比 42.7， = 0.03），而心理成分评分无统计学差异（ = 0.09）。
肥胖患者即使在长期随访中也能获得相似的疼痛强度和功能状态的改善。对于有适当手术适应证的患者，肥胖不应被视为 MIS-TLIF 手术的禁忌症。
