Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2021 | Obesity | Research

Evaluation of full-endoscopic lumbar discectomy in the treatment of obese adolescents with lumbar disc herniation: a retrospective study

Authors: Haijiang Yu, Bin Zhu, Qingpeng Song, Xiaoguang Liu

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

Obese patients are at risk of complications after spinal surgery. Full-endoscopic lumbar discectomy (FELD) has advantages over conventional open surgery in the treatment of obese adult patients with lumbar disc herniation (LDH) because it can decrease perioperative complications and enhance the degree of patient satisfaction. However, no clinical studies have evaluated the efficacy of FELD in obese adolescents with LDH (ALDH). This study aimed to evaluate the efficacy of FELD for the treatment of obese ALDH.

Methods

We retrospectively collected clinical data from 208 patients with single-segment ALDH who underwent FELD in our hospital between January 2015 and December 2019. According to the WHO classification of obesity, the patients were divided into obese (BMI ≥30 kg/m²) and non-obese (BMI < 30 kg/m²) groups (control group). Based on the preoperative baseline data of the two groups, propensity score matching was performed to select patients from these groups for a comparative study. Perioperative data included operative time, intraoperative blood loss, and length of postoperative hospitalization. The visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria were recorded as the main indicators of the surgical outcome. Recurrence rate and incidence of complications were recorded as minor indicators.

Results

Twenty-eight patients and 80 patients were included in the obese and non-obese groups, respectively, after 1:4 propensity score matching. Both groups showed improvements in VAS and ODI scores after surgery and at each follow-up time point (p < 0.05). However, there was no significant statistical difference in the surgical outcomes between the two groups at each follow-up time point (p > 0.05). The differences in operative time, intraoperative blood loss, and length of postoperative hospitalization were not statistically significant between the two groups (p > 0.05).

Conclusion

FELD is a safe and effective minimally invasive technique for treating obese patients with ALDH. The efficacy of FELD in obese and non-obese patients with ALDH was comparable.

Lee JY, Ernestus RI, Schröder R, Klug N. Histological Study of Lumbar Intervertebral Disc Herniation in Adolescents. Acta Neurochir (Wien). 2000;142(10):1107–1110. https://doi.org/10.1007/s007010070037.

Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg 2007;43(2):77–81. https://doi.org/10.1159/000098377.

Wang H, Cheng J, Xiao H, Li C, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment Centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg 2013;115(8):1415–1419. https://doi.org/10.1016/j.clineuro.2013.01.019.

Mattila VM, Saarni L, Parkkari J, Koivusilta L, Rimpelä A. Early risk factors for lumbar discectomy: an 11-year follow-up of 57,408 adolescents. Eur Spine J 2008;17(10): 1317–1323. https://doi.org/10.1007/s00586-008-0738-2.

Abdallah DY, Jadaan MM, McCabe JP. Body mass index and risk of surgical site infection following spine surgery: a meta-analysis. Eur Spine J. 2013;22(12):2800–9. https://doi.org/10.1007/s00586–013–2890-6.CrossRef

Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95(1):1–8. https://doi.org/10.2106/JBJS.K.01558.

Jiang J, Teng Y, Fan Z, Khan S, Xia Y. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta analysis Clin Orthop Relat Res 2014;472(3):968–975. https://doi.org/10.1007/s11999-013-3346-3.

Cole JS 4th, Jackson TR. Minimally invasive lumbar discectomy in obese patients. Neurosurgery. 2007;61(3):539–544. https://doi.org/10.1227/01.NEU.0000290900.23190.C9.

Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083-3010. https://doi.org/10.1002/sim.3697

10.

Huskisson EC. Measurement of pain. Lancet 1974;2(7889):1127–1131. https://doi.org/10.1016/s0140-6736(74)90884-8.

11.

Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271–3.

12.

Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971;53(5):891–903. https://doi.org/10.2106/00004623-197153050-00004.CrossRef

13.

Kraemer R, Wild A, Haak H, Herdmann J, Krauspe R, Kraemer J. Classification and management of early complications in open lumbar microdiscectomy. Eur Spine J 2003;12(3):239–246. https://doi.org/10.1007/s00586-002-0466-y.

14.

Silvers HR, Lewis PJ, Clabeaux DE, Asch HL. Lumbar disc excisions in patients under the age of 21 years. Spine (Phila Pa 1976) 1994;19(21):2387–2391. https://doi.org/10.1097/00007632-199411000-00002.

15.

Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019;185:105486. https://doi.org/10.1016/j.clineuro.2019.105486.

16.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang XR, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–781. https://doi.org/10.1016/S0140-6736(14)60460-8.

17.

Ni Mhurchu C, Rodgers A, Pan WH, Gu DF, Woodward M. Body mass index and cardiovascular disease in the Asia-Pacific region: an overview of 33 cohorts involving 310 000 participants. Int J Epidemiol 2004 Aug;33(4):751–758. https://doi.org/10.1093/ije/dyh163.

18.

Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–578. https://doi.org/10.1016/S0140-6736(08)60269-X.

19.

Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085–1095. https://doi.org/10.1016/S0140-6736(11)60105-0.

20.

Li Y, Shi JJ, Ren J, Guan HS, Gao YP, Zhao F, Sun J. [Relationship between obesity and lumbar disc herniation in adolescents]. Zhongguo Gu Shang. 2020;33(8):725-729. Chinese. https://doi.org/10.12200/j.issn.1003-0034.2020.08.008

21.

De la Garza-Ramos R, Bydon M, Abt NB, Sciubba DM, Wolinsky JP, Bydon A, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine(Phila Pa 1976).2015;40(1):56–61. https://doi.org/10.1097/BRS.0000000000000655.

22.

McGuire KJ, Khaleel MA, Rihn JA, Lurie JD, Zhao W, Weinstein JN. The effect of highobesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976) 2014;39(23):1975–1980. https://doi.org/10.1097/BRS.0000000000000577.

23.

Li Z, Zhang C, Chen W, Li S, Yu B, Zhao H, Shen J, Zhang J, Wang Y, Yu K Percutaneous endoscopic Transforaminal discectomy versus conventional open lumbar discectomy for upper lumbar disc herniation: a comparative cohort study. Biomed Res Int 2020;2020:1852070. https://doi.org/10.1155/2020/1852070, 1852077.

24.

Kim M, Lee S, Kim HS, Park S, Shim SY, Lim DJ. A comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation in the Korean: a meta-analysis. Biomed Res Int 2018;2018:9073460. https://doi.org/10.1155/2018/9073460, 9073468.

25.

Li H, Jiang C, Mu X, Lan W, Zhou Y, Li C. Comparison of MED and PELD in the treatment of adolescent lumbar disc herniation: a 5-year retrospective follow-up. World Neurosurg. 2018;112:e255-e260. https://doi.org/10.1016/j.wneu.2018.01.030.

26.

Bae JS, Lee SH. Transforaminal full-endoscopic lumbar discectomy in obese patients. Int J Spine Surg. 2016;10:18. https://doi.org/10.14444/3018

27.

Wang YP, Zhang W, An JL, Zhang J, Bai JY, Sun YP. Evaluation of Transforaminal endoscopic discectomy in treatment of obese patients with lumbar disc herniation. Med Sci Monit 2016;22:2513–2519. https://doi.org/10.12659/msm.899510.

28.

Haddadi K. Pediatric lumbar disc herniation: a review of manifestations, diagnosis and management. J Pediatr Rev. 2016;4(1):e4725. https://doi.org/10.17795/jpr-4725.

29.

Bayliss MT, Johnstone B, O'Brien JP. 1988 Volvo award in basic science. Proteoglycan synthesis in human intervertebral discs variation with age, region, and pathology Spine (Phila pa 1976). 1988;13(9):972-981. https://doi.org/10.1097/00007632-198809000-00003, 13, 9, 972, 981.

30.

Gulati S, Madsbu MA, Solberg TK, Sørlie A, Giannadakis C, Skram MK, Nygaard ØP, Jakola AS Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study. Acta Neurochir 2017;159(3):509–516. https://doi.org/10.1007/s00701-017-3077-4.

31.

Xu Z, Liu Y, Chen J. Percutaneous endoscopic Interlaminar discectomy for L5-S1 adolescent lumbar disc herniation. Turk Neurosurg 2018;28(6):923–928. https://doi.org/10.5137/1019-5149.JTN.21579-17.3.

32.

Ahn SS, Kim SH, Kim DW. Learning curve of percutaneous endoscopic lumbar discectomy based on the period (early vs. late) and technique (in-and-out vs. in-and-out-and-in): a retrospective comparative study. J Korean Neurosurgical Soc 2015;58(6):539–546. https://doi.org/10.3340/jkns.2015.58.6.539.

33.

D'Astorg H, Fière V, Dupasquier M, Vieira TD, Szadkowski M: Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery. Orthop Traumatol Surg Res 2020;106(6): 1167–1173. https://doi.org/10.1016/j.otsr.2020.01.017.

34.

Madsbu MA, Øie LR, Salvesen Ø, Vangen-Lønne V, Nygaard ØP, Solberg TK, Gulati S Lumbar microdiscectomy in obese patients: a multicenter observational study. World Neurosurg 2018;110:e1004-e1010. https://doi.org/10.1016/j.wneu.2017.11.156.

35.

Choi I, Ahn JO, So WS, Lee SJ, Choi IJ, Kim H. Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J 2013;22(11):2481–2487. https://doi.org/10.1007/s00586-013-2849-7.

36.

Li X, Bai J, Hong Y, Zhang J, Tang H, Lyu Z, Liu S, Chen S, Liu J: Minimum seven-year follow-up outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease. Int J Gen Med 2021, 14:779–785. https://doi.org/10.2147/IJGM.S293400.

37.

Kim HS, You JD, Ju CI. Predictive scoring and risk factors of early recurrence after percutaneous endoscopic lumbar discectomy. Biomed Res Int. 2019;2019:6492675. https://doi.org/10.1155/2019/6492675

38.

Wu J, Zhang C, Lu K, Li C, Zhou Y. Percutaneous endoscopic lumbar reoperation for recurrent sciatica symptoms: a retrospective analysis of outcomes and prognostic factors in 94 patients. World Neurosurg. 2018;109:e761-e769. https://doi.org/https://doi.org/10.1016/j.wneu.2017.10.077

39.

Yao Y, Liu H, Zhang H, Wang H, Zhang C, Zhang Z, Wu J, Tang Y, Zhou Y. Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy. World Neurosurg. 2017 Apr;100: 1–6. https://doi.org/10.1016/j.wneu.2016.12.089.

40.

Yin S, Du H, Yang W, Duan C, Feng C, Tao H. Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis. Pain Physician. 2018;21(4):337–50.

Title: Evaluation of full-endoscopic lumbar discectomy in the treatment of obese adolescents with lumbar disc herniation: a retrospective study
Authors: Haijiang Yu
Bin Zhu
Qingpeng Song
Xiaoguang Liu
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Obesity
Obesity
Spinal Surgery
Lumbar Disc Herniation
Lumbar Disc Herniation
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04449-5

At a glance: The STEP trials

Springer Medicine

Evaluation of full-endoscopic lumbar discectomy in the treatment of obese adolescents with lumbar disc herniation: a retrospective study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Design and rationale of the ATtune Knee Outcome Study (ATKOS): multicenter prospective evaluation of a novel uncemented rotating platform knee system

Intraoperative three-dimensional imaging in ankle syndesmotic reduction

Effective factors on Sharp Score in patients with rheumatoid arthritis: a retrospective study

Urinary pentosidine level is associated with grip strength and gait speed in community-dwelling adults: a cross-sectional study

Material properties of human vertebral trabecular bone under compression can be predicted based on quantitative computed tomography

Association between diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in patients with cervical myelopathy: a retrospective observational study