Tubular microsurgery for lumbar discectomies and laminectomies in obese patients: operative results and outcome.

STUDY DESIGN: This is a retrospective single-center case study involving 115 obese and nonobese patients who underwent minimally invasive lumbar surgery between 2004 and 2007.

OBJECTIVE: The purpose of this study was to evaluate the effect of minimally invasive spinal surgery in obese and nonobese patients by operative results and patient outcomes.

SUMMARY OF BACKGROUND DATA: Spinal surgery in obese patients is associated with increased complications, blood loss, and operative times. The potential benefits of minimally invasive lumbar surgery in obese patients are discussed.

METHODS: All patients underwent 1-level lumbar microdiscectomy or laminectomy using tubular retractors. Data were collected on patient demographics, comorbidities, smoking habits, operative results, and clinical outcomes, and compared for obese and nonobese patients. Operative results included operative times, blood loss, length of stay, and perioperative complications. Clinical outcomes were assessed by using pre- and postoperative visual analog scale and Macnab outcome criteria at most recent follow-up.

RESULTS: In this study, 31% of 115 patients were classified as obese. Obese patients tended to undergo surgery at a younger age. Obesity, comorbidities, and age did not have an impact on patient outcome at a mean follow-up of 15.9 months. No significant differences were seen between obese versus nonobese patients in terms of incision lengths, operative time, blood loss, and complication rates. In obese patients, all parameters and operative results compared favorably to reported historical results of patients undergoing open lumbar surgery. Overall, favorable outcome was seen in 92% and 84% of obese and nonobese lumbar microdiscectomy patients, respectively, and in 75% of laminectomy patients. Postoperative visual analog scale did not show any significant difference.

CONCLUSION: This is the first study comparing operative results from tubular microsurgery between obese and nonobese patients. No major differences were detected in outcome, operative and perioperative data including complication rates. With tubular microsurgery, obese patients experienced the same or equally beneficial outcome, compared to nonobese patients, while incision lengths, blood loss, operative times, and length of stay were less when compared to open procedures. Other comorbidities and age had no significant impact on perioperative complications and clinical outcome.