Transforaminal full-endoscopic lumbar discectomy in obese patients

Abstract

Background: Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients.

Methods: Obesity is defined as a body mass index (BMI) of more than 30 kg/m2. Our study included 21 obese patients and 27 normal BMI patients treated by posterolateral transforaminal ELD for radiating pain caused by a single-level lumbar disc herniation with more than 2 years of follow-up. Clinical chart reviews and telephone surveys were conducted. Clinical and functional outcomes using VAS and ODI, perioperative complications, and reherniation were evaluated.

Results: Overall clinical and functional outcomes were improved during postoperative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In obese group, three patients had late reherniations. Of these, 2 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient who had undergone ELD for recurrent disc herniation underwent open microdiscectomy. In control group, two patients had early reherniation and underwent open microdiscectomy and one patient with late reherniation showed good recovery with conservative treatment.

Conclusion: In select cases, ELD is an effective, safe, and minimally invasive technique for obese patients. It decreases perioperative morbidity and allows for both early mobilization and early return to work.

Level of evidence: level 3b.

Keywords: complication; discectomy; endoscopic; obesity; transforaminal.

Fig. 1

Case illustration: A 25-year-old woman presenting with radiating pain on her right leg. Preoperative MRI scan showing lumbar disc herniation at the L5-S1 level, right. (A, B) Her BMI was 38.9 kg/m². Transforaminal ELD was performed, and the symptoms were alleviated. Postoperative MRI scan showing good decompression (C, D).

Fig. 2

Case illustration: A 56-year-old woman with arrhythmia, diabetes, and a lumbar disc herniation at the right L4-5 level. The herniation had migrated slightly downward (A, B). Her BMI was 32.5 kg/m². Transforaminal ELD was performed, and symptoms were relieved. Postoperative MRI scan showing good decompression (C, D).