Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis

Bansal, Parth; Vatkar, Arvind; Baburaj, Vishnu; Kumar, Vishal; Dhatt, Sarvdeep Singh

doi:10.1007/s00402-023-04870-6

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…In addition, the substantial load borne by the lower lumbar intervertebral discs in severely obese patients exacerbates degeneration, making the nucleus pulposus and annulus fibrosus more susceptible to rupture under equivalent external forces [ 27 ]. Furthermore, the likelihood of vascular sclerosis or injury of the upper and lower endplate in severely obese individuals contributes to impediments in the supply of nutrients, resulting in metabolic imbalances, reduced matrix synthesis, increased acid metabolites, and diminished water content in the nucleus pulposus [ 8 , 28 ]. Together, these factors contribute to the appearance of disc herniation and pose challenges for postoperative disc repair.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional open laminectomy serves as a prevalent clinical intervention for LDH, effectively mitigating mechanical compression within the spinal canal. However, the inherent drawbacks of the procedure, such as excessive manipulation of the paravertebral muscles that leads to a greater risk of hemorrhage and an increased incidence of postoperative adhesion, warrant consideration [ 8 ]. Moreover, the utilization of general anesthesia in traditional procedures introduces elevated anesthesia-associated risks, prolonged postoperative recovery, and heightened susceptibility to complications like urinary tract infections and pneumonia [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…While individual studies have investigated the association between obesity and FETD outcomes [ 8 – 10 ], a comprehensive evaluation of the current evidence is warranted. Systematic reviews and meta-analyses offer a robust approach to synthesize existing knowledge and identify key trends.…”

Section: Introductionmentioning

confidence: 99%

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Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

Feng,

Yu,

Chen

et al. 2024

BMC Musculoskelet Disord

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Objective This study aimed to assess the impact of full endoscopic transforaminal discectomy (FETD) on clinical outcomes and complications in both obese and non-obese patients presenting with lumbar disc herniation (LDH). Methods A systematic search of relevant literature was conducted across various primary databases until November 18, 2023. Operative time and hospitalization were evaluated. Clinical outcomes included preoperative and postoperative assessments of the Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, conducted to delineate improvements at 3 months postoperatively and during the final follow-up, respectively. Complications were also documented. Results Four retrospective studies meeting inclusion criteria provided a collective cohort of 258 patients. Obese patients undergoing FETD experienced significantly longer operative times compared to non-obese counterparts (P = 0.0003). Conversely, no statistically significant differences (P > 0.05) were observed in hospitalization duration, improvement of VAS for back and leg pain scores at 3 months postoperatively and final follow-up, improvement of ODI at 3 months postoperatively and final follow-up. Furthermore, the overall rate of postoperative complications was higher in the obese group (P = 0.02). The obese group demonstrated a total incidence of complications of 17.17%, notably higher than the lower rate of 9.43% observed in the non-obese group. Conclusion The utilization of FETD for managing LDH in individuals with obesity is associated with prolonged operative times and a higher total complication rate compared to their non-obese counterparts. Nevertheless, it remains a safe and effective surgical intervention for treating herniated lumbar discs in the context of obesity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

Feng,

Yu,

Chen

et al. 2024

BMC Musculoskelet Disord

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“…A substantial body of previous research has consistently substantiated a strong correlation between BMI and LDH, as well as the identification of overweight and obesity as risk factors for PRLDH. 19 , 20 Moreover, Siccoli et al’s 20 prospective study identified the highest incidence of PRLDH among overweight smokers. Smoking’s impact on PRLDH occurrence may involve: 1) misalignment and damage to the annulus fibrosus, 21 2) nicotine-induced vasoconstriction inhibiting proteoglycan synthesis, rendering the intervertebral disc more vulnerable, 22 3) chronic cough increasing intradiscal pressure, 23 and 4) influencing wound healing.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Nomogram Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Activity Factors

Tang,

Wang,

Wang

et al. 2024

RMHP

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Purpose To develop an individualized predictive model for postoperative recurrent lumbar disc herniation (PRLDH) in patients undergoing percutaneous endoscopic transforaminal discectomy (PETD) by considering postoperative activity factors. Patients and Methods Retrospectively collected data from 612 LDH patients who underwent PETD in our institution from January 2017 to June 2023. They were divided into a training group (429 cases) and a validation group (183 cases). Lasso regression (Model 1) and random forest (Model 2) were applied for variable selection in the training group. The two models were compared in terms of discrimination (the area under curve, AUC), calibration (calibration curve), and clinical utility (decision curve analysis, DCA). Akaike information criterion (AIC) was used for model comparison, and internal validation employed 1000 times Bootstrap + 10-fold cross-validation. Finally, a Nomogram was constructed to display the results and uploaded to the web version. Results Among 612 treated LDH patients, 66 (10.78%) developed PRLDH. Model 1, superior in AUC, calibration, DCA, and AIC over Model 2, was chosen as the predictive model. Logistic regression in the training group identified BMI, smoking, activity level score, time to first ambulation, diabetes, Modic change, and Pfirrmann grade as independent predictors of PRLDH. Model 1 exhibited a training group AUC of 0.813 (95% CI 0.753–0.872) and a validation group AUC of 0.868 (95% CI 0.773–0.962). At a Youden index of 0.50, sensitivity was 0.73, specificity was 0.77. Internal validation (1000 times Bootstrap + 10-fold cross-validation) for the training group showed accuracy of 0.889, kappa consistency of 0.112, and AUC of 0.757. The Hosmer-Lemeshow goodness-of-fit tests indicated good discriminative ability for Model 1 in both the training ( χ 2 =2.895, P =0.941) and validation groups ( χ 2 =8.197, P =0.414). The DCA and Nomogram are accessible at https://sofarnomogram.shinyapps.io/PRLDHNom/ . Conclusion The Nomogram predictive model, developed based on postoperative activity factors in this study, demonstrates excellent predictive capability, facilitating risk assessment for the occurrence of PRLDH after PETD.

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“…A study of 41 patients with a body mass index > 30 kg/m 2 who underwent endoscopic lumbar decompression procedures showed that they were able to achieve significant improvements in pain and disability without high amounts of blood loss or postoperative complications [ 52 ]. The mean operative time was shorter in endoscopic discectomy patients compared to those who underwent open microdiscectomy in obese patients with a BMI > 30 kg/m 2 [ 53 ].…”

Section: Advantages Of Endoscopic Spine Surgerymentioning

confidence: 99%

Advances and Challenges of Endoscopic Spine Surgery

Burkett,

Brooks

2024

JCM

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The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations throughout its development. It can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Continued clinical research is needed to explore its expanding indications. Although the limitations of starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are still present. As more residency and fellowship programs include endoscopy as part of their spine training, it will become more prevalent in hospitals in the United States. Technological advancements in spine surgery will further propel and enhance endoscopic techniques as they become an integral part of a spine surgeon’s repertoire.

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Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis

Cited by 6 publications

References 31 publications

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

Development and Validation of a Nomogram Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Activity Factors

Advances and Challenges of Endoscopic Spine Surgery

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