Background This study aims to assess the clinical and radiographic outcomes of biportal endoscopic lumbar discectomy compared to microscopic lumbar discectomy in obese patients with lumbar herniated discs. Previous research has established a positive correlation between operation time and estimated blood loss in obese patients undergoing microscopic lumbar discectomy, based on an increase in body mass index. However, no studies have specifically examined the outcomes of biportal endoscopic lumbar discectomy in this patient population. Therefore, this study seeks to fill this research gap and provide valuable insights into the effectiveness of these two surgical approaches for obese patients with lumbar herniated discs.
Methods This retrospective multicenter study analyzed and compared clinical and radiological data from 48 obese patients with a body mass index (BMI) greater than 30 kg/m2 who underwent either microscopic or biportal endoscopic lumbar discectomy. The study assessed clinical outcomes using the visual analog scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scores. Radiological data were obtained through magnetic resonance imaging (MRI) scans.
Results The study included a total of 48 patients, with 31 patients undergoing microscopic discectomy and 17 patients undergoing biportal endoscopic discectomy. Both groups showed improvements in VAS, ODI, and EQ-5D scores following surgery compared to preoperative scores. However, there was no significant difference in these outcome measures between the two surgical techniques. Although there was a no significant difference in the occurrence of recurrent disc herniation confirmed by postoperative MRI, there was significant difference in the number of patients requiring additional surgery between the two groups.
Conclusions For obese patients with lumbar disc herniation that did not respond to conservative treatment, this study found no significant differences in clinical or radiological outcomes between microscopic and biportal endoscopic surgery methods. However, it is worth noting that the biportal group had a lower incidence of reoperation compared to the microscopic group.
Background When obese patients underwent lumbar discectomy using a microscope, a correlation was found between the operation time and an increase in estimated blood loss according to the increase in body mass index.
However, except for minor complications, there was no difference in postoperative outcomes between obese and normal-weight patients. These are the results of microscopic lumbar discectomy in obese patients, but there are no studies on biportal endoscopic lumbar discectomy. The aim of this study was to compare the clinical and radiographic outcomes of microscopic and endoscopic discectomy in obese patients.
Methods Clinical and radiological data were compared and analyzed in 23 obese patients with a body mass index of >30 kg/m2 who underwent microscopic and biportal endoscopic lumbar discectomy. Clinical data on the visual analog scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scores were measured, and radiological data were measured using magnetic resonance imaging (MRI).
Results In total, 13 patients who underwent microscopic discectomy and 10 who underwent biportal endoscopic discectomy were enrolled in this study. The VAS, ODI, and EQ-5D scores in both groups improved after surgery compared with those before surgery, although there was no difference between the two groups. Although there was a difference in the incidence of recurrent disc herniation confirmed by MRI after surgery, there was no difference in the number of patients requiring surgery between the two groups.
Conclusions There were no significant clinical or radiological differences in outcomes between microscopic and biportal endoscopic surgery methods.
Purpose The purpose of the study was to investigate the effect of obesity on the accuracy of percutaneous pedicle screw placement.
Materials and Methods We performed a retrospective analysis on the first 89 patients undergoing minimally invasive lumbar fusion with percutaneous pedicle screw placements for the treatment of degenerative lumbar spinal disorder.
Based on patient’s body mass index (BMI), patients were divided into 3 groups: group 1 – normal weight (BMI<25, 38 patients, 157 screws); group 2 – overweight (25≤BMI<30, 29 patients, 124 screws); group 3 – obese (BMI≥30, 22 patients, 89 screws). Using postoperative computed tomography (CT) scans, the position of placed screws to the pedicle or anterior body perforation was evaluated using the following grading method: Grade A, completely in the range without pedicle cortex violation; Grade B, pedicle wall violation<2 mm; Grade C, pedicle wall violation 2 to 4 mm; and Grade D, pedicle wall violation>4 mm.
Results Among the 370 pedicle screws, 308 screws (83%) were perfectly placed within the pedicle. Among the 62 misplaced screws, 45 screws were grade B pedicle breaches (73%, 45/62), and 45 screws were misplaced in lateral direction (73%, 45/62). 36 screws (10%) perforated the anterior vertebral cortex. Twenty eight screws were misplaced in overweight group, 12 screws in obese group, and 22 screws in normal weight group. With the number of screws available, subgroup analysis did not reveal a significant difference in the grade (p=0.10) or the direction (p=0.97) of pedicle breaches among groups.
Conclusion Our data suggest that obesity does not affect the accuracy of percutaneous pedicle screw placement. We do not hesitate or deny the surgery because of patient’s heavy body habitus, which seems to be a apparent benefit of minimally invasive spinal surgery.
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