Original ArticlePercutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation in Obese Patients: Health-Related Quality of Life Assessment in a 2-Year Follow-Up
Introduction
Obesity is a dominant public health problem with increasing prevalence.1 According to body mass index (BMI), a widely used parameter for robust evaluation of body fat, a BMI of 18.5–22.9 kg/m2 is considered normal body weight,2 a BMI of 25–29.9 kg/m2 is defined as overweight, and a BMI of ≥30 kg/m2 is defined as obesity.3 Elevated BMI is associated with overloading of the musculoskeletal system, especially affecting the lumbar spine.4, 5 Obesity has been established as a risk factor for lumbar disc herniation (LDH).2 Increased pressures can damage the integrity of intervertebral discs.6 Degenerative alterations of intervertebral discs seem to constitute the salient etiology for onset of low back pain (LBP).1 LBP affects 80% of the general population and is considered a significant socioeconomic problem.7
Minimal invasive spine surgery provides a beneficial alternative to conventional surgical approaches in the obese population.8 Percutaneous transforaminal endoscopic discectomy (PTED) is a rapidly evolving surgical technique in the field of LDH treatment. This surgical technique provides spine surgeons with the ability to approach the epidural space through the intervertebral foramen, enabling work in the anatomic triangle (safe zone).9 PTED is associated with less soft tissue trauma, preservation of dorsal musculature, shorter hospitalization times, reduced perioperative morbidity, and earlier return to work.10, 11
To the best of our knowledge, PTED in obese patients with LDH has been reported in only 2 previous publications, with parallel demonstrations of outcomes and safety.2, 8 However, evaluation of the efficacy of PTED included only the assessment of pain and neurologic function in both cases. Neither of the studies reported specific results regarding the impact of PTED on the patients' postoperative quality of life. The aim of the present study was to evaluate outcomes of PTED after 2 years of follow-up in a cohort of obese patients. This is the first report on assessment of health-related quality of life (HRQoL) after PTED in obese patients with LDH using the Short-Form 36 (SF-36) medical health survey questionnaire.
Section snippets
Study Population
Our study cohort included patients with LDH who were appropriate candidates for discectomy, meeting all current indications. All patients were referred to the same spine surgeon (K.S.), and all procedures were performed at the Interbalkan European Medical Center in Thessaloniki, Greece. Patients were fully informed about the principles and aims of this study, and agreed to participate by providing informed written consent. The study was approved by the hospital's Medical Council and the local
Results
All patients successfully completed follow-up. Demographic characteristics of patients in the 2 groups are presented in Table 1. Baseline preoperative values of all SF-36 indices studied are provided in Table 2.
Preoperative evaluation showed that almost all of the parameters, including VAS-LP, VAS-BP, and SF-36 indices (except GH), were statistically significantly enhanced in group B compared with group A, despite the small differences in ultimate percentages between the 2 groups in the
Obesity and LBP
Obesity is a significant social health concern.1 Ogden et al.15 reported a 36.5% prevalence of obesity in US adults during 2011–2014. Numerous pathological conditions are associated with obesity, including diabetes, cardiovascular disorders, and osteoarthritis, demonstrating the multifaceted profile of this health condition.16
Obesity is defined by the World Health Organization as a BMI ≥30 kg/m2. Morbid obesity is defined as BMI ≥35 kg/m2 with 2 major comorbid conditions (e.g., diabetes,
Conclusions
Values of all evaluated indices were statistically significantly enhanced at 2 years postoperatively in the 2 groups, demonstrating the favorable outcomes of PTED in obese patients. However, the overwhelming majority of group A patients had lower scores at all follow-up intervals, demonstrating less clinical improvement, compared with the group B patients. PTED appears to be a generally safe and efficient technique for treating LDH in obese patients when performed by an experienced spine
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Conflict of interest statement: Dr. Kapetanakis is a reference doctor for joimax GmbH and receives payments for teaching. The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.