Liawrungrueang Wongthawat, Cholamjiak Watcharaporn, Sarasombath Peem, Sakti Yudha Mathan, Wu Pang Hung, Wu Meng-Huang, Lu Yu-Jen, Yau Lo Cho, Ito Zenya, Cho Sung Tan, Chang Dong-Gune, Lim Kang Taek
Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand.
Department of Mathematics, School of Science, University of Phayao, Phayao, Thailand.
Asian Spine J. 2025 Apr;19(2):292-310. doi: 10.31616/asj.2024.0376. Epub 2025 Apr 7.
Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.
肥胖给脊柱手术带来了重大挑战，包括围手术期并发症发生率更高、手术时间延长和恢复延迟。传统的开放性脊柱手术往往会加剧这些风险，尤其是在肥胖患者中，因为需要广泛的组织解剖和更大的切口。内镜脊柱手术（ESS）已成为一种有前景的微创替代方案，具有组织创伤小、失血量少、感染率低和恢复快等优点。本系统评价和荟萃分析旨在评估ESS技术（包括全内镜和双门内镜腰椎间盘切除术及减压术）在肥胖和腰椎病变患者中的安全性、有效性和手术结果。对PubMed/Medline、Embase和Scopus数据库进行全面的文献检索，共检索到2000年至2024年间发表的2975项研究，其中10项符合纳入标准。荟萃分析显示，疼痛缓解（视觉模拟量表）和功能结果（奥斯威斯功能障碍指数）有显著改善，肥胖患者和非肥胖患者的结果相当。肥胖患者的手术时间更长，症状复发风险略高；然而，与传统手术相比，ESS的伤口感染率更低、住院时间更短且恢复更快。这些发现表明，ESS是治疗肥胖患者腰椎疾病的一种可行且有效的选择，在应对肥胖相关手术挑战的同时保持良好的临床结果。然而，研究异质性和缺乏随机对照试验等局限性凸显了进一步开展高质量研究以完善ESS技术并优化该高危人群患者护理的必要性。
