Orthopedics ( IF 1.1 ) Pub Date : 2022-04-06 , DOI: 10.3928/01477447-20220401-05 Daniel Coban , Stuart Changoor , Stephen Saela , Kumar Sinha , Ki Hwang , Michael Faloon , Arash Emami
Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. The larger body habitus of obese patients increases the intraoperative complexity of MI-TLIF. Therefore, it is unclear whether this procedure is appropriate for this population. The goal of this study was to compare postoperative outcomes for obese patients vs nonobese patients undergoing MI-TLIF through a matched cohort analysis. A retrospective review was performed to identify patients who underwent MI-TLIF at a single institution with a minimum follow-up of 5 years. Patients were divided into 2 cohorts: nonobese (body mass index <30 kg/m2) and obese (body mass index ≥30 kg/m2). Each cohort was matched for age, sex, and levels operated. Perioperative data and patient-reported outcomes were compared. Radiographic outcomes were measured at final follow-up. Standard binomial and categorical comparative analyses were performed. A total of 148 patients were included. Of obese patients, 17.6% required revision surgery compared with 16.2% of nonobese patients (P=.826). Both cohorts had a similar proportion of pelvic incidence-lumbar lordosis mismatch correction (P=.780). Mean change in functional outcome scores for each cohort did not differ significantly. Obese patients had clinically minor but statistically significantly greater blood loss and longer operative times than nonobese patients (P<.001). Obese and non-obese patients undergoing MI-TLIF showed no long-term differences in revision rate, radiologic outcome, or functional outcome after long-term follow-up. Obese patients had slightly greater blood loss and longer operative times. Our findings suggest that MI-TLIF is an appropriate alternative to traditional open lumbar fusion for obese patients. [Orthopedics. 202x;4x(x):xx–xx.]
中文翻译:
肥胖不会对微创经椎间孔腰椎椎间融合术的长期结果产生不利影响:匹配队列分析
微创经椎间孔腰椎椎间融合术(MI-TLIF)是一种治疗退行性脊柱疾病的成熟技术。肥胖患者较大的体型增加了 MI-TLIF 的术中复杂性。因此,尚不清楚该程序是否适合该人群。本研究的目的是通过匹配队列分析比较肥胖患者与接受 MI-TLIF 的非肥胖患者的术后结果。进行回顾性审查以确定在单一机构接受 MI-TLIF 的患者,至少随访 5 年。患者分为 2 个队列:非肥胖(体重指数 <30 kg/m 2)和肥胖(体重指数 ≥30 kg/m 2)。每个队列都匹配年龄、性别和操作水平。围手术期数据和患者报告的结果进行了比较。在最终随访时测量影像学结果。进行了标准的二项式和分类比较分析。共纳入 148 名患者。在肥胖患者中,17.6% 的患者需要进行翻修手术,而在非肥胖患者中这一比例为 16.2% ( P =.826)。两个队列的骨盆发病率 - 腰椎前凸不匹配矫正比例相似(P =.780)。每个队列的功能结果评分的平均变化没有显着差异。与非肥胖患者相比,肥胖患者的失血量在临床上较小,但在统计学上显着增加且手术时间较长(P<.001)。在长期随访后,接受 MI-TLIF 的肥胖和非肥胖患者在翻修率、放射学结果或功能结果方面没有长期差异。肥胖患者的失血量略大,手术时间更长。我们的研究结果表明 MI-TLIF 是肥胖患者传统开放式腰椎融合术的合适替代方案。[骨科。202x;4x(x):xx–xx.]