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Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Data availability

All data generated or analyzed during this study are included in this manuscript.

Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

EBL:

Estimated blood loss

EQ-5D-5L:

EuroQol 5-dimension and 5-level

LE-ULBD:

Lumbar endoscopic unilateral laminotomy for bilateral decompression

MIS:

Minimally invasive surgery

ODI:

Oswestry disability index

SSI:

Surgical site infections

VAS:

Visual analog scale

VTE:

Venous thromboembolism

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Acknowledgements

The authors thank Sharon Durfy, PhD for assistance with manuscript preparation. The research team would like to extend thanks to the Endoscopic Spine Research Group (ESRG) of which ONK and CPH are members. We also thank the Raisbeck family foundation for their generous support. 

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Julia Bergquist and Madeline E. Greil have contributed equally to this report and should be considered co-first authors.

Authors and Affiliations

  1. Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA

    Julia Bergquist

  2. Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA

    Madeline E. Greil & Christoph P. Hofstetter

  3. Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA

    Siri Sahib S. Khalsa & Osama N. Kashlan

  4. Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Yuhao Sun

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Contributions

Conceptualization and Design: CPH; Acquisition of Data: JB; Analysis and Interpretation of Data: MEG, ONK, CPH; Drafting the Article: MEG, JB, YS, ONK; Critically Revising Article: MEG, ONK, CPH; Review Submitted Version of Manuscript: all authors; Statistical Analysis: SSSK, ONK; Study Supervision: ONK, CPH.

Corresponding author

Correspondence to Christoph P. Hofstetter.

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Conflict of interest

Dr. Hofstetter is a consultant for Joimax, Globus Medical, Innovasis, and Johnson & Johnson.

Ethical approval

The University of Washington Human Subjects Division reviewed and approved this retrospective research study (IRB07742) with a waiver of informed consent, appropriately compliant with institutional requirements, and conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Bergquist, J., Greil, M.E., Khalsa, S.S.S. et al. Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression. Eur Spine J 32, 2748–2754 (2023). https://doi.org/10.1007/s00586-023-07705-5

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