A study published in the Journal of Spinal Disorders and Techniques compares minimally invasive transforaminal lumbar interbody fusion to the open procedure for obese patients.
The prospective evaluation includes 81 patients with a body mass index of 25 or more. Obesity is typically associated with increased complications, blood loss and operative times for spine surgery. Here are five findings:
1. The minimally invasive surgical patients had significantly shorter operative time and blood loss. An article published in the American Journal of Orthopedics in 2012 examined the challenges for spine surgery in obese patients, including:
• Obtaining imaging
• Comorbidities such as coronary disease and diabetes
• Anesthesia administration
• Wound infection
• Deep vein thrombosis risk increases
However, the study authors concluded, "appropriate clinical outcomes can be achieved in obese patients who undergo spine surgery. Obesity is not a contraindication for spine surgery. Patient selection is key in achieving favorable outcomes."
2. There was less postoperative back pain among patients who underwent the less invasive procedures. The two groups had nearly identical Oswestry Disability Index scores.
3. Radiation time was significantly longer in the minimally invasive group, which is particularly concerning for physicians who are exposed to radiation during procedures on a daily basis. "Although this technique needs a longer x-ray exposure time, it may still be a good option for overweight or obese patients," concluded the study authors.
A study recently published in Spine examined the difference between freehand and navigated radiation exposure during pedicle screw placement and found the accumulated radiation dose was significantly higher for the non-navigational group.
4. Radiographic evidence showed satisfactory bony union at the fixed level in both groups. "MiTLIF is a safe and reliable procedure for treatment of overweight or obese patients. The minimally invasive technique offers several potential advantages when compared with the open procedure," concluded the study authors.
5. Overall complications were significantly higher among the open group. The complication rate for overweight or obese patients in the open group was 17.9 percent. A 2012 study published in Spine and highlighted in HealthDay found morbidly obese patients had a complication rate of nearly 14 percent, compared with 7 percent for other patients, meaning morbid obesity increased complication risk by 97 percent.
The study also found morbidly obese patients who underwent spinal fusion had higher hospital costs — $109,000 compared with $85,000 for non-morbidly obese patients — and stayed in the hospital 1.3 days longer.
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