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

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Abstract

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-024-07455-5.

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Most cited references 28

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Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Tiffany Powell-Wiley, Paul Poirier, Lora E Burke … (2021)

The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.

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Obesity and spine surgery: relation to perioperative complications.

Nimesh Patel, Bradley Bagan, Sumeet Vadera … (2007)

Many patients undergoing elective thoracic or lumbar fusion procedures are obese, but the contribution of obesity to complications in spine surgery has not been defined. The authors retrospectively assessed the prevalence of obesity in a cohort of patients undergoing thoracic and lumbar fusion and correlate the presence of obesity with the incidence of operative complications. A retrospective review of consecutive patients treated by a single surgeon (J.K.R.) over a 36-month period at either Rush University Medical Center or the Neurological and Orthopedic Institute of Chicago was performed. The authors identified 332 elective thoracic and lumbar spine surgery cases; the cohort was restricted to include only patients with symptomatic degenerative conditions in need of an anterior, posterior, or combined anterior-posterior fusion. Cases of trauma, tumor, and infection and any case in which the procedure was performed for emergency indications were excluded. A total of 97 cases were identified; of these 86 procedures performed in 84 patients had adequate follow-up material for inclusion in the present study. A broad definition of complications was used. Complications were divided into adverse events (minor) and significant complications (major) based on their impact on patient outcome. Stepwise multivariate logistic regression was used to identify which variables had a significant effect on the risk of complications. Variables considered were body mass index (BMI), height, weight, age, sex, presence or absence of diabetes mellitus (DM) and/or hypertension, number of levels fused (single compared with multiple), and type of surgery performed. The mean BMI for the cohort was 28.8 (95% confidence interval 24.4-30.3); 60 patients (71.4%) were considered overweight or obese (BMI > or = 25). There were 42 complications in 31 patients (36.9%); this included 19 significant complications in 17 patients (20.2%). Logistic regression revealed that the probability of a significant complication was related to BMI (p or = 40). The probability of minor complication occurrence increased with age (p < 0.02), not BMI. The rate of complications was independent of sex as well as the presence of DM or hypertension. A standard collection of complications occurred, including wound infection (three cases), cerebrospinal fluid leakage (eight cases, one requiring reoperation), deep vein thrombosis (two cases), cardiac events (four cases), symptomatic pseudarthrosis (one case), pneumonia (three cases), prolonged intubation (two cases), urological issues (eight cases), positioning-related palsy (two cases), and neuropathic pain (two cases). Obesity is a prevalent condition in patients undergoing elective fusion for degenerative spinal conditions and may increase the prevalence and incidence of perioperative complications. In their analysis, the authors correlated increasing BMI and increased risk of significant postoperative complications. The correlation of obesity and perioperative complications may assist in the preoperative evaluation and selection of patients for surgery.

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A Review of Obesity, Physical Activity, and Cardiovascular Disease

Andrew Elagizi, Sergey Kachur, Salvatore Carbone … (2020)

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Author and article information

Contributors

Guang-Xun Lin: linguangxun@hotmail.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 23 April 2024

Publication date PMC-release: 23 April 2024

Publication date Collection: 2024

Volume: 25

Electronic Location Identifier: 322

Affiliations

[1 ]Department of Orthopedics and Traumatology of Traditional Chinese Medicine, The Third Hospital of Xiamen, Xiamen, China

[2 ]Department of clinical laboratory, The Third Hospital of Xiamen, Xiamen, China

[3 ]Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, ( https://ror.org/05d9dtr71) Changhua, Taiwan

[4 ]Department of Leisure Industry Management, National Chin-Yi University of Technology, ( https://ror.org/040bs6h16) Taichung, Taiwan

[5 ]Department of Biomedical Sciences, National Chung Cheng University, ( https://ror.org/0028v3876) Chiayi, Taiwan

[6 ]GRID grid.412625.6, Department of Anesthesia and Surgery, , The first affiliated Hospital of Xiamen University, Xiamen University, ; Xiamen, Fujian China

[7 ]GRID grid.12955.3a, ISNI 0000 0001 2264 7233, Department of Orthopedics, School of Medicine, , The First Affiliated Hospital of Xiamen University, Xiamen University, ; Xiamen, China

[8 ]The Third Clinical Medical College, Fujian Medical University, ( https://ror.org/050s6ns64) Fuzhou, Fujian China

Article

Publisher ID: 7455

DOI: 10.1186/s12891-024-07455-5

PMC ID: 11040856

PubMed ID: 38654321

SO-VID: e2163796-7f8f-40ce-b1d3-943115905d15

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 21 December 2023

Date accepted : 17 April 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003392, Natural Science Foundation of Fujian Province;

Award ID: 2021J05282

Funded by: FundRef http://dx.doi.org/10.13039/100010166, Xiamen Municipal Bureau of Science and Technology;

Award ID: 3502Z20224033

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: obese,full endoscopic spine surgery,transforaminal,disc herniation,bmi

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: obese, full endoscopic spine surgery, transforaminal, disc herniation, bmi

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

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Abstract

Objective

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Conclusion

Supplementary Information

Related collections

Orthopedics

Most cited references 28

Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Obesity and spine surgery: relation to perioperative complications.

A Review of Obesity, Physical Activity, and Cardiovascular Disease

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