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Erschienen in: HSS Journal ® 2/2020

01.07.2020 | CURRENT CONCEPTS IN SPINAL FUSION / Review Article

Minimally Invasive Spine Lumbar Surgery in Obese Patients: A Systematic Review and Meta-Analysis

verfasst von: Yahya A. Othman, Abduljabbar Alhammoud, MD, Osama Aldahamsheh, MBBCh, Avani S. Vaishnav, MBBS, Catherine Himo Gang, MPH, Sheeraz A. Qureshi, MD, MBA

Erschienen in: HSS Journal ® | Ausgabe 2/2020

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Abstract

Background

Transforaminal lumbar interbody fusion (TLIF) is the treatment of choice for lumbar spinal stenosis and spondylolisthesis. The procedure can be performed through a traditional open approach (O-TLIF) or through minimally invasive techniques (MI-TLIF). Spinal surgeries in obese patients can pose risks, including increased rates of infection and thromboembolic events.

Questions/Purposes

We sought to systematically review the literature on the differences between MI-TLIF and O-TLIF in the obese patient in terms of complication rate, functional outcomes, blood loss, and length of hospital stay.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically search PubMed, Embase, Web of Science, and the Cochrane Library for studies published through February 2019 and identified those comparing the outcomes of O-TLIF and MI-TLIF in obese patients. The primary outcome was complication rate (total, infections, dural tears); secondary outcomes were blood loss, length of hospital stay, and functional scores. Two authors independently reviewed the studies using the Newcastle-Ottawa Scale, and data were pooled using the Mantel-Haenszel random-effects model.

Results

In the sample of 430 patients, the average age was 53.5 years, there were 153 men and 203 women, and the average body mass index was 33.6. Complications were significantly higher in O-TLIF than in MI-TLIF (OR = 0.420 [95% CI: 0.199, 0.887]; I2 = 45.20%). No difference was detected between the two groups for visual analog scale back pain scores and Oswestry Disability Index scores between the pre-operative and last follow-up visits (SMD = –0.034 [95% CI –0.695, 0.627]; I2 = 62.14% and SMD = 0.617 [95% CI: –1.082, 2.316]; I2 = 25%, respectively). Blood loss was significantly lower in MI-TLIF compared to O-TLIF (SMD = –426.736 [95% CI: –490.720, –362.752]; I2 = 70.53%), as was the duration of hospital stay (SMD = –1.079 [95% CI: –1.591, –0.208]; I2 = 84.3%).

Conclusion

MI-TLIF has equivalent efficacy to O-TLIF in obese patients at long-term follow-up. In addition, complication rate, blood loss, and length of hospital stay were lower in MI-TLIF than in O-TLIF.
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Metadaten
Titel
Minimally Invasive Spine Lumbar Surgery in Obese Patients: A Systematic Review and Meta-Analysis
verfasst von
Yahya A. Othman
Abduljabbar Alhammoud, MD
Osama Aldahamsheh, MBBCh
Avani S. Vaishnav, MBBS
Catherine Himo Gang, MPH
Sheeraz A. Qureshi, MD, MBA
Publikationsdatum
01.07.2020
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 2/2020
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-019-09735-6

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