Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.
Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
Eur Spine J. 2023 Aug;32(8):2748-2754. doi: 10.1007/s00586-023-07705-5. Epub 2023 May 11.
Obesity is associated with increased surgical complexity and postoperative complications in spine surgery. Minimally invasive procedures have been shown to lessen some of the increased risk in obese patients. This study investigated whether utilization of a working channel endoscope can further mitigate obesity-associated challenges in spinal surgery.
A retrospective review of a single-surgeon database was conducted for all adult patients undergoing full-endoscopic unilateral laminotomies for bilateral decompression between November 2015 and March 2021. Data collected included body mass index, in operating room preparation time, procedure time, length of hospital stay, use of analgesics, complications, and quality of life measured by Oswestry Disability Index.
Our cohort included 174 patients. Of these, 74 (42.5%) were obese. The average age was 63.6 years. In-operating room preparation time was 70.0 ± 1.7 min for obese patients and 64.4 ± 1.5 min for non-obese patients (p = 0.02). There was no difference in operative time, durotomy rates or other perioperative complications between obese and non-obese patients. Hospital length of stay trended toward longer in the obese group, but did not reach significance. A greater percentage of obese patients were still using both narcotic and non-narcotic pain medications 2 weeks after surgery. There was no significant difference in functional outcomes between groups.
Full-endoscopic unilateral laminotomies for bilateral decompression are safe and effective in both non-obese and obese patients. The use of an endoscope can partially mitigate obesity-related morbidity in lumbar decompression. However, obesity is significantly related to increased postoperative analgesic use.
肥胖与脊柱手术中手术复杂性增加和术后并发症相关。微创手术已被证明可以降低肥胖患者的一些风险。本研究旨在探讨使用工作通道内窥镜是否可以进一步减轻肥胖相关的脊柱手术挑战。
对 2015 年 11 月至 2021 年 3 月期间，一位外科医生的所有接受单侧全内镜椎板切开术双侧减压的成年患者进行了单中心回顾性数据库研究。收集的数据包括体重指数、手术前准备时间、手术时间、住院时间、镇痛药的使用、并发症和生活质量（Oswestry 残疾指数）。
我们的队列包括 174 名患者，其中 74 名（42.5%）肥胖。平均年龄为 63.6 岁。肥胖患者的手术前准备时间为 70.0±1.7 分钟，非肥胖患者为 64.4±1.5 分钟（p=0.02）。肥胖患者与非肥胖患者的手术时间、硬脊膜切开率或其他围手术期并发症无差异。肥胖组的住院时间有延长的趋势，但无统计学意义。术后 2 周，更多的肥胖患者仍在使用阿片类药物和非阿片类药物止痛。两组患者的功能结果无显著差异。
双侧减压的单侧全内镜椎板切开术在非肥胖和肥胖患者中均安全有效。内窥镜的使用可以部分减轻腰椎减压术中与肥胖相关的发病率。然而，肥胖与术后镇痛药物使用增加显著相关。
