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| GU Guangfei,ZHANG Hailong,HE Shisheng.The effect of body mass index on the outcome of minimally invasive surgery for lumbar spinal stenosis complicated with lumbar instability[J].Chinese Journal of Spine and Spinal Cord,2012,(4):313-317. |
| The effect of body mass index on the outcome of minimally invasive surgery for lumbar spinal stenosis complicated with lumbar instability |
| Received:January 05, 2012 Revised:February 24, 2012 |
| English Keywords:Spinal stenosis Lumbar instability Minimally invasive surgery Body mass index |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the effect of body mass index on the outcome of minimally invasive decompression and transforaminal lumbar interbody fusion with percutaneous pedicle screw internal fixation for lumbar spinal stenosis complicated with lumbar instability. Methods: A retrospective study was carried on 57 cases with single segment lumbar spinal stenosis complicated with lumbar instability undergoing bilateral decompression via unilateral approach and transforaminal lumbar interbody fusion through an expandable tubular retractor and percutaneous pedicle screw internal fixation from March 2010 to March 2011. All patients were divided into three groups according to BMI. Group A: normal weight(BMI＜25kg/m2), 14 males and 17 females; Group B: overweight (25kg/m2≤BMI＜30kg/m2), 7 males and 12 females; Group C: obese(BMI≥30kg/m2), 3 males and 4 females. The operation time, intraoperative blood loss, postoperative hospital stay and complications were recorded. Low back pain was assessed by JOA scores(29) and Oswestry disability index(ODI) at pre- and post-operation(six months and final follow-up). The fusion rates were evaluated based on the Bridwell criterion at final follow-up. There was no statistical difference in age, sex, JOA scores, ODI before surgery, follow-up period among three groups(P＞0.05). The clinical efficacy was compared among three groups. Results: There was significant difference with respect to operation time(P＜0.05); while no statistical difference for blood loss or postoperative hospital stay among three groups(P＞0.05). Leakage of cerebrospinal fluid was noted in 1 case respectively in group A and C. 1 case in group B used autogenous bone graft without cage because of osteoporosis. Delayed healing of the skin incision were found in 4 cases and all healed after antibiotic treatment and dressing change 15-18 days after surgery. All patients were followed up for 8-20 months. JOA scores and ODI scale showed statistically significant improvements(P＜0.05), and there was no statistical difference in JOA scores and ODI among three groups at six months after surgery and final follow- up(P＞0.05). Based on the JOA improvement rate, there were 25 excellent, 5 good and 1 fair in group A, 12 excellent and 7 good in group B, 4 excellent and 3 good in group C. Three groups got similar clinical efficacy at final follow-up. The fusion rates in group A, B, C was 93.5%, 94.7% and 100% respectively(P＞0.05), and there were no cages or pedicle screws related complications. Conclusions: Minimally invasive decompression and transforaminal lumbar interbody fusion with percutaneous pedicle screw internal fixation is reliable for single segment lumbar spinal stenosis complicated with lumbar instability. Patients with different BMI have the same clinical outcome. |
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