European Spine Journal

, Volume 21, Issue 12, pp 2626–2632 | Cite as

Posterior lumbar spinal fusion and instrumentation in morbidly obese patients using the Synframe retractor system: technical note

  • Rahul Vaidya
  • Anil Sethi
  • Adrienne Lee
  • Steve Bartol
  • Ndidi Onwudiwe
  • Max Aebi
Original Article

Abstract

Purpose

Lumbar spine surgery in morbidly obese patients is a challenge to the operating surgeon. The aim of the study was to evaluate the surgical experience in this group of patients using the Synframe retractor system (Synthes, Paoli, PA, USA) as a tool for improved surgical access.

Methods

An Institutional Review Board approved retrospective study was conducted on 43 morbidly obese patients undergoing posterior lumbar decompression instrumentation and fusion. Patient selection was based on a BMI of >40. Information acquired included BMI, set up time, procedure time, ASA, intraoperative blood loss and the number of preoperative co-morbidities of each patient. Postoperative complications, length of stay, and pre-operative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS) were recorded at each postoperative visit. They were compared to 45 age matched controls from our spine database.

Results

The average set-up time (73.5 min), amount of blood loss (average 1,040 mL), length of incision (10.3–14.5 cm) and length of hospital stay (5.4 days) were recorded. The average surgical time was dependent on the procedure and number of levels fused and ranged from 164 to 245 min. These parameters were compared with normal weight patients and noted to be higher.

Conclusion

The surgical experience determined that the Synframe retractor system provided a stable and well-illuminated operative field. It minimized the number of personnel required for assistance and improved surgical access. As may be expected, all the above recorded parameters were greater in the morbidly obese group.

Keywords

Obesity Lumbar fusion Synframe 

Notes

Conflict of interest

None.

References

  1. 1.
    DeMaria EJ (2007) Bariatric surgery for morbid obesity. N Engl J Med 356(21):2176–2183PubMedCrossRefGoogle Scholar
  2. 2.
    National Institutes of Health (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6(suppl 2):51S–209SGoogle Scholar
  3. 3.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555PubMedCrossRefGoogle Scholar
  4. 4.
    Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A (2009) Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976) 34(5):495–500Google Scholar
  5. 5.
    Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234PubMedCrossRefGoogle Scholar
  6. 6.
    Passannante AN, Tielborg M (2009) Anesthetic management of patients with obesity with and without sleep apnea. Clin Chest Med 30(3):569–579PubMedCrossRefGoogle Scholar
  7. 7.
    Aebi M, Steffen T (1998) Synframe: a preliminary report. Eur spine J 9(suppl.1) S44–S50Google Scholar
  8. 8.
    Sterba W, Do-Gyoon Kim, Fyhrie DP, Yeni YN, Vaidya R (2007) Biomechanical analysis of differing pedicle screw insertion angles. Clin Biomech 22(4):385–391CrossRefGoogle Scholar
  9. 9.
    Telfeian AE, Reiter T, Durham SR, Marcotte P (2002) Spine surgery in morbidly obese patients. J Neurosurg Spine 97:20–24CrossRefGoogle Scholar
  10. 10.
    Kossman T, Jacobi D, Trentz O (2001) The use of retractor system (Synframe) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J 10:396–402CrossRefGoogle Scholar
  11. 11.
    Mayer HM (2000) The ALIF concept. Eur Spine J 9(suppl.1): S35–S45Google Scholar
  12. 12.
    Kawaguchi Y, Matsui H, Tsuji H (1996) Back muscle injury after posterior lumbar spine surgery: a histologic and enzymatic analysis. Spine 21(8):941–944PubMedCrossRefGoogle Scholar
  13. 13.
    Lehto M, Hurme M, Alaranta H, Einola S, Falck B, Jarvinen M, Kalimo H, Mattttila M, Paljarvi L (1989) Connective tissue changes of the multifidus muscle in patients with lumbar disc herniation. An immunohistologic study of collagen types I and III and fibronectin. Spine 14(3):302–309PubMedCrossRefGoogle Scholar
  14. 14.
    Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 203:7–17PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Rahul Vaidya
    • 1
  • Anil Sethi
    • 1
  • Adrienne Lee
    • 1
  • Steve Bartol
    • 2
  • Ndidi Onwudiwe
    • 1
  • Max Aebi
    • 3
  1. 1.Department of Orthopaedic Surgery, Detriot Medical CenterDetroit Receiving HospitalDetroitUSA
  2. 2.Department of Orthopedic Surgery, Henry Ford Health SystemSentio, LLCSouthfieldUSA
  3. 3.Orthopaedic SurgeryUniversity of BernBernSwitzerland

Personalised recommendations