Effect of obesity on results of endoscopic versus open lumbar discectomy
Abstract
A comparative meta-analysis assessing the impact of obesity on lumbar discectomy outcomes. The study stratifies results by surgical technique, revealing that endoscopic approaches significantly mitigate the heightened complication risks traditionally associated with obese patients.
Minimally Invasive Neutralization of Obesity Risks
Key Finding
"Endoscopic discectomy in obese patients resulted in significantly lower overall complication rates compared to open surgery (OR 0.33, p = 0.03) and reduced hospital stay by nearly 2 days (p < 0.0001)."
Background: Obesity is a known independent risk factor for perioperative morbidity in spine surgery, often complicating exposure and wound healing. As the global BMI rises, surgeons face a dilemma: does the minimally invasive endoscopic approach offer a tangible protective benefit over the gold-standard open microdiscectomy in this high-risk demographic?
Methods: The authors analyzed 8 studies comprising data from obese (BMI > 30) and non-obese cohorts undergoing lumbar discectomy. A subgroup analysis compared Endoscopic Lumbar Discectomy (ELD) versus Open Lumbar Discectomy (OLD) specifically within the obese population. Primary outcomes included recurrence, reoperation, and complication rates.
Results: In the broad analysis, obese patients had a significantly higher recurrence rate (OR 1.76, p = 0.002) and reoperation rate (OR 1.83, p = 0.003) than non-obese patients, regardless of technique. However, when isolating the surgical approach in obese patients, Endoscopic Discectomy proved superior to Open Discectomy: it reduced the odds of complications by 67% (OR 0.33) and significantly shortened operative time and hospital stay (p < 0.05). Blood loss was also significantly lower in the endoscopic group.
Conclusion: While obesity remains a risk factor for recurrence, the surgical hit can be minimized. Endoscopic discectomy effectively neutralizes the wound-related morbidity associated with deep open dissections in obese patients, making it the preferred approach for this specific phenotype.