The effect of subcutaneous fat and skin-to-lamina distance on complications and functional outcomes of minimally invasive lumbar decompression

Haggai Schermann*, Uri Hochberg, Gilad J. Regev, Khalil Salame, Dror Ofir, Ran Ankori, Zvi Lidar, Morsi Khashan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Minimally invasive lumbar decompression (MIS) in obese pzatients is technically challenging due to the use of longer tube retractors. The purpose of this study was to evaluate the impact of the thickness of the soft tissue and subcutaneous fat on complications, revisions, and patient-reported functional outcomes after MIS. Methods: This is a retrospective analysis of 148 consecutive patients who underwent minimally invasive lumbar decompression at our institute between 2013 and 2017 and had at least one year of follow-up. Analysis was performed five times, each time the study group was defined by another measure of adiposity: BMI > 30, skin to lamina distance at the site of surgery and at L4 > 6 cm, and subcutaneous fat thickness at the site of surgery and at L4 > 3 cm. Outcomes included intraoperative complications (durotomy or neurological deficit), possibly inadequate decompression (residual disc, reoperation), length of stay, return to the emergency room or readmission, postoperative medical complications, and functional outcomes: visual analog scores for back and leg pain, and Oswestry Disability Index (ODI). Results: Patients with a thicker layer soft tissue had a significantly higher burden of comorbidities than controls, including higher prevalence of cardiovascular disease (p = 0.002), diabetes (p < 0.001), hypertension (p < 0.001) and higher ASA scores (p = 0.002). Nevertheless, there was no significant difference between the patient groups in surgical and medical complications, functional outcomes, and other assessed outcomes. Conclusion: Our results indicate that minimally invasive lumbar decompression is safe and effective for patients with a thick layer of soft tissue and subcutaneous fat.

Original languageEnglish
Pages (from-to)2031-2039
Number of pages9
JournalInternational Orthopaedics
Volume47
Issue number8
DOIs
StatePublished - Aug 2023
Externally publishedYes

Keywords

  • Complications
  • Minimally invasive decompression
  • Obesity
  • Skin-to-lamina distance
  • Subcutaneous fat thickness

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